Cardiovascular risk evaluation and prevalence of silent myocardial ischemia in subjects with asymptomatic carotid artery disease

Marco Matteo Ciccone¹, Artor Niccoli-Asabella², Pietro Scicchitano¹, Michele Gesualdo¹, Antonio Notaristefano², Domenico Chieppa¹, Santa Carbonara¹, Gabriella Ricci¹, Marco Sassara¹, Corinna Altini², Giovanni Quistelli¹, Mario Erminio Lepera¹, Stefano Favale¹, Giuseppe Rubini^2
1Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), ²Nuclear Medicine Unit, Department of Internal Medicine and of Public Medicine, University of Bari, Bari, Italy

Introduction: Silent ischemia is an asymptomatic form of myocardial ischemia, not associated with angina or anginal equivalent symptoms, which can be demonstrated by changes in ECG, left ventricular function, myocardial perfusion, and metabolism. The aim of this study was to evaluate the prevalence of silent myocardial ischemia in a group of patients with asymptomatic carotid stenosis.
Methods: A total of 37 patients with asymptomatic carotid plaques, without chest pain or dyspnea, was investigated. These patients were studied for age, sex, hypertension, diabetes, dyslipidemia, smoking, and family history of cardiac disease, and underwent technetium-99 m sestamibi myocardial stress-rest scintigraphy and echo-color Doppler examination of carotid arteries.
Results: A statistically significant relationship (P = 0.023) was shown between positive responders and negative responders to scintigraphy test when both were tested for degree of stenosis. This relationship is surprising in view of the small number of patients in our sample. Individuals who had a positive scintigraphy test had a mean stenosis degree of 35% ± 7% compared with a mean of 44% ± 13% for those with a negative test. Specificity of our detection was 81%, with positive and negative predictive values of 60% and 63%, respectively.
Conclusion: The present study confirms that carotid atherosclerosis is associated with coronary atherosclerosis and highlights the importance of screening for ischemic heart disease in patients with asymptomatic carotid plaques, considering eventually plaque morphology (symmetry, composition, eccentricity or concentricity of the plaque, etc) for patient stratification.

Keywords: asymptomatic carotid artery disease, silent myocardial ischemia, myocardial stress scintigraphy