Abstract 483: Carotid Imaging During Dobutamine Stress Echocardiography: Should It Become the Norm?
Introduction: Ultrasound detection of extra cranial focal intrusive carotid plaque (CP) is an important predictor of cardiovascular events and confers a 10-year risk of myocardial infarction as high as 25%. Moreover, patients with asymptomatic carotid stenosis >60% may benefit from endarterectomy. We evaluated the usefulness of routine carotid scanning in clinical decision making, in patients referred for Dobutamine Stress Echo (DSE).
Methods: We studied 108 consecutive patients (50 male, age 63.9±11.6 years) having DSE in our lab. Patients with any prior cerebrovascular event were excluded. Carotid scanning was performed during recovery. An artery affected by CP was defined as one where there was localized thickening of 1.2 mm that did not uniformly involve the whole common carotid bifurcation with or without flow disturbance. When necessary, Doppler was performed to assess severity. A peak systolic velocity of >125 cm/s was used to define a >50% stenosis.
Results: CP was detected in 90 patients (83.3%). Based on the results of the DSE and carotid scanning, four groups of patients were identified (see table 1⇓). Two patients (1.9%) had significant (>50%) stenosis of the internal carotid. Both of these patients had abnormal DSE. Of the 24 patients with normal DSE and abnormal carotid scanning only 14 were on statin and aspirin; thus a subpopulation of 10 patients (9.3% of the total) was identified that could benefit from more aggressive risk factor modification. The mean scanning time of both carotids was 4.5±2.0 min, however since this was performed during recovery it did not prolong the total exam time.
Conclusions: Routine carotid scanning in patients referred for DSE is useful since it provides additional information, with no net increase in time. In our study this changed the management in a significant proportion (11.2%) of patients.