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JournalofCardiology64(2014)70–74ContentslistsavailableatScienceDirectJournalofCardiologyjournalhomepage:www.elsevier.com/locate/jjccOriginalarticleTheclinicalusefulnessofcarotidultrasonographyinpatientswithaninconclusiveexercisetreadmillstresstestresultCanYucelKarabay(MD),GonencKocabay(MD)∗,AhmetGuler(MD),ArzuKalayci(MD),TaylanAkgun(MD),CevatKirma(MD)KartalKosuyoluHeartandResearchHospital,CardiologyDepartment,Istanbul,TurkeyarticleinfoArticlehistory:Received29June2013Receivedinrevisedform4October2013Accepted25October2013Availableonline20December2013Keywords:ExercisetreadmilltestInconclusiveresultCarotidintima-mediathicknessMyocardialperfusionimagingstudyabstractBackground:Althoughatreadmillexercisestresstesting(EST)isoftenthefirst-linescreeningprocedureforsubjectswithanintermediateprobabilityofcoronaryarterydisease(CAD),onelimitationofthistestisthehighrateofinconclusiveteststhatresultfromborderlineexercise-inducedSTchanges.Thecarotidintimamediathickness(CIMT)correlateswellwithatherosclerosis.ThepurposeofthisstudywastoevaluatetheclinicalusefulnessofperformingCIMTmeasurementsinpatientswithaninconclusiveEST.Methods:SymptomaticpatientswithouthistoryofvasculardiseaseandwithinconclusiveESTresultwereincluded.InconclusiveresultsweredefinedasthepresenceofhorizontalordownslopingST-segmentdepressionbetween0.5and0.9mmor1.0and1.4mmupslopingST-segmentdepression.AfterinconclusiveESTregardingelectrocardiographicchanges,themeasurementsoftheCIMTandmyocardialperfusionimagingstudy(MPS)wereperformedinallpatients.TheCIMTwasmeasuredattheposteriorwallofthecommoncarotidartery.ThediagnosisofCADwasbasedonthepresenceofreversibleperfusiondefectsonexerciseMPS.Results:Atotalof87patients(57men)withameanageof58.9±7.2yearswereenrolled.TheMPSwaspositivein18patients.TheCIMTinpatientswithpositiveMPSwassignificantlygreaterthaninpatientswithnegativeMPS.TheCIMTwas0.82±0.33mminpatientswithpositiveMPSand0.63±0.21mminpatientswithnegativeMPS(p=0.004).Receiveroperatingcharacteristiccurveanalysesrevealedthatthegreatestspecificitywasobtainedwhenthecut-offvalueofCIMTwassetat0.66mm(sensitivity39%;specificity72.5%;positivepredictivevalue27%;negativepredictivevalue82%).Conclusion:InpatientswithinconclusiveelectrocardiographicchangesduringEST,CIMTwasausefulmeasurementtopreventalternativemoreexpensiveandinvasivetests.Additionally,meanCIMTisusefulforscreeningpatientswithaninconclusiveESTresulttoexcludeCAD.©2013JapaneseCollegeofCardiology.PublishedbyElsevierLtd.Allrightsreserved.IntroductionExercisetreadmillstresstesting(EST)isausefuldiagnostictoolforprimaryassessmentofsymptomaticpatientswithaninter-mediateprobabilityofcoronaryarterydisease(CAD)basedonclinicalfindings[1].However,onelimitationisthehighrateofnondiagnostictests.ESTresultshavebeenclassifiedasnegative(noevidenceofreversibleischemia),positive(moderatelyorseverelyabnormal),orequivocal(reportedasnondiagnostic,sub-optimal,equivocal,possiblyartifactualorminimallyabnormal)[2].Whilethemostdeterminedreasonforthehighrateofnondiagnos-ticteststhatresultfrompatients’failuretoreachthetargetheartrate,anotherreasonresultsfrominconclusiveelectrocardiographic∗Correspondingauthorat:DepartmentofCardiac,ThoracicandVascularSciences,UniversityofPadua,CentroGallucci,ViaGiustiniani2,35128Padua,Italy.Tel.:+390498218642;fax:+390498761764.E-mailaddress:gonenckocabay@yahoo.com(G.Ko...