Validity of Carotid Intima-Media Thickness on B-Mode Ultrasonography in the Diagnosis of Coronary Artery Disease Keeping Coronary Angiography as Gold Standard
DOI:
https://doi.org/10.70749/ijbr.v3i5.2734Keywords:
Coronary Artery Disease, Carotid intima–media Thickness, B-mode Ultrasonography, Diagnostic Validity, Risk Stratification.Abstract
Background: Carotid intima–media thickness (CIMT) measured by B-mode ultrasonography is a non-invasive marker of systemic atherosclerosis and has been proposed as a surrogate indicator for coronary artery disease (CAD), particularly in resource-limited settings. Objective: To evaluate the diagnostic validity of carotid intima–media thickness (CIMT) for detecting angiographically confirmed coronary artery disease (CAD) in an angiography-referred population at a tertiary care hospital in Islamabad, Pakistan. Methods: The study was conducted in the Department of Radiology at Islamabad Medical Complex in collaboration with the Cardiology Department. It was designed as a cross-sectional diagnostic accuracy (validation) study and was carried out from December 2024 to Feb 2025. Participants were recruited using consecutive (non-probability) sampling from patients scheduled for coronary angiography, either through the outpatient clinic or as admitted ward patients. Results: At a CIMT cutoff of ≥0.9 mm, sensitivity was 80.6%, specificity 80.8%, positive predictive value 56.8%, negative predictive value 93.0%, and overall diagnostic accuracy 80.8%. The positive likelihood ratio was 4.2 and the negative likelihood ratio was 0.24, indicating that a negative CIMT result meaningfully reduced the post-test probability of angiographically significant CAD. The observed prevalence of angiographically confirmed CAD in this study population was 23.8%. Conclusion: CIMT demonstrates good diagnostic performance with a high negative predictive value in this angiography-referred population, supporting its use as a non-invasive adjunct for CAD risk stratification and exclusion. CIMT does not replace coronary angiography but may assist clinical decision-making and triage, particularly in resource-constrained settings. Further multicenter studies are warranted to validate these findings.
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