Background: Coronary artery disease is a major cause of left ventricular systolic dysfunction. With successful revscularization, LV function and prognosis can be improved, differentiation of significant coronary artery disease from other etiology is important in heart failure management. But, in advanced state of heart failure, it is difficult to differentiate underlying etiology with echocardiography or other clinical variables, due to features so called ‘dilated cardiomyopathy’ are common. Carotid intima-media thickness (IMT) is one of useful predictors for cardiovascular disease including stroke and coronary artery disease. So it can be postulated that carotid IMT provide a diagnostic clue for ischemic etiology in advanced heart failure.
Methods: 73 heart failure patients (47 male, 67.6±12.4 yrs) with LV dilatation (LV end diastolic dimension >55mm) and severe LV systolic dysfunction (LVEF≤30%) were enrolled. Coronary angiography and carotid ultrasound were performed. Severity of coronary artery disease was analyzed by Duke Jeopardy Score system and carotid IMT was measured with data standard from Mannheim Carotid IMT Consensus.
Results: In coronary angiography, there was no significant luminal narrowing in 32 patients(jeopardy score=0) and 41 patients showed significant stenosis (jeopardy score ≥2). Carotid IMT were significantly higher in patients with coronary artery steosis : common carotid artery(CCA) IMT 0.74±0.05 vs 1.04±0.04mm, p=0.0055; carotid bulb IMT 0.86±0.02 vs 1.22±0.04mm, p=0.0016. Visible plaque in carotid bulb was significant predictor for coronary artery stenosis: odd ratio of plaque in CCA for coronary artery disease 3.63, 95% confidence interval 0.72-18.49, p=0.198, plaque in carotid bulb OR 4.69, 95% CI 1.70-12.96, p=0.0029. Even in 29 low probable group for coronary artery disease (no history of DM, no Q wave in ECG), there were 8 patients(27.6%) with significant coronary artery disease (jeopardy score 4=3, 8=2, 10=3). Visible plaque in carotid bulb was a significant predictor for coronary artery stenosis in low probable group also (OR 7.08, 95% CI 1.17-42.8, p=0.0329).
Conclusion: In patients with severe LV systolic dysfunction, probably there are significant numbers of patients with inappropriate diagnosis for coronary artery disease. Carotid IMT can be a useful diagnostic tool for predicting coronary artery disease as underlying etiology.
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