Detection of subclinical coronary atherosclerosis using two-dimensional, high-resolution transthoracic echocardiography

OBJECTIVES We evaluated whether two-dimensional high-resolution transthoracic echocardiography (HR-2DTTE) can detect changes in arterial wall thickness and size associated with subclinical coronary artery disease (CAD). BACKGROUND Arterial wall thickening, compensatory arterial enlargement and a preserved arterial lumen characterize subclinical atherosclerosis. Detection of these changes during the asymptomatic stage of CAD may allow early treatment and prevention of acute coronary events. METHODS Twenty-six patients with angiographically proven CAD and 29 normal volunteers underwent HR-2DTTE evaluation of the left anterior descending coronary artery (LAD) using an ATL 5000 echograph (Advanced Technology Laboratories, Bothell, Washington) with a 4 to 7 MHz transducer. Significant (>70%) LAD stenosis was present in 15 patients (mean 82%); 11 patients did not have significant LAD stenosis (mean 26%) and represented a surrogate for subclinical LAD disease. Wall thickness, maximal luminal diameter and external diameter of the LAD were measured. RESULTS Left anterior descending coronary artery wall thickness was larger in patients (1.9 ± 0.4 mm) than it was in volunteers (0.9 ± 0.1 mm, p < 0.001). The external diameter of the LAD was (6.0 ± 1.1 mm) in patients and (3.9 ± 0.7 mm) in volunteers (p < 0.001). Luminal diameter was 2.2 ± 0.5 mm in patients and 2.1 ± 0.6 mm in volunteers (p = NS). There was no difference in wall thickness (1.9 ± 0.4 mm vs. 2.0 ± 0.4 mm), luminal diameter (2.2 ± 0.5 mm vs. 2.2 ± 0.4 mm) and external diameter (5.9 ± 1.0 mm vs. 6.2 ± 1.2 mm) between the patients with <70% and >70% LAD stenosis. CONCLUSIONS Left anterior descending coronary artery wall thickness and external diameter are significantly increased in patients with CAD as compared with normal subjects, and HR-2DTTE is sensitive enough to detect these differences. Wall thickness and external diameter are increased to the same extent in patients with obstructive and subclinical LAD disease.