EVALUATION OF THE CAROTID INTIMA-MEDIA THICKNESS IN PATIENTS WITH SEVERE AORTIC-STENOSIS

Coronary angiography is a recommended investigation in the preoperativ e assessment of aortic valve replacement for aortic stenosis in the ab sence of a reliable non-invasive diagnostic method. Ultrasonographic q uantification of carotid artery intima-media thickness, being correlat ed to the severity of coronary atherosclerosis, could therefore be use ful in the screening of coronary artery disease in severe aortic steno sis. The authors studied a group of 100 patients (69.5 +/- 8.5 years : 64 men) with severe aortic stenosis. A central group of 45 patients w ith coronary artery disease without valvular disease (69.5 +/- 6 years : 30 men) was used for reference. Significant coronary artery disease was found in 21 of the 100 study cases. The average intima-media thic kness was 0.608 +/- 0.090 mm. There was no significant difference in i ntima-media thickness between the coronary and non-coronary patients o f the study group (0.612 +/- 0.094 mm and 0.607 +/- 0.094 mm respectiv ely). It was, however, significantly greater in the control group pati ents compared with the 21 coronary patients in the study group (0.699 +/- 0.082 mm and 0.612 +/- 0.094 mm : p = 0.0004). Finally, 71.1 % of patients in the control group had atheromatous carotid artery plaques compared with 59 % in the study group (p = 0.005). The measurement of carotid intima-media thickness does not allow detection of coronary pa tients in severe aortic stenosis. The finding of a lower intima-media thickness in this population compared with coronary patients without v alvular disease suggests that aortic stenosis may have a protective ef fect on the wall thickness of carotid arteries.