Vascular Screening During Transthoracic Echocardiography: Specialty Practice-Based Prospective Monocentre Observational Study Including a Three-Year Follow-up

Abstract

Background: Abdominal aortic aneurysm and atherosclerotic alterations of the carotid arteries are well known silent threatening conditions. Transthoracic echocardiography (TTE) is a potential tool for opportunistic screening of extra-cardiac vascular anomalies. We studied the additional diagnostic yield and therapeutic impact of vascular screening during TTE in patients referred to a practising cardiologist and therefore in a presumably high-risk patient group. Design, Method: 306 patients consecutively referred to a practising cardiologist underwent vascular screening during standard TTE. Vascular recordings were made of the maximal infra-renal abdominal aorta diameter as well as the intima-media thickness (IMT) of common carotid arteries and thickness of atherosclerotic plaques in common and internal carotid arteries. After an adjusted, guideline-directed medical treatment was completed, a three-year followup- survey was undertaken by means of a questionnaire sent to the referring physicians. Results: After exclusion of three patients for equivocal imaging, 303 patients were studied (188 males), aged 65±15, of whom 89 patients (29%) were known for coronary artery disease (CAD). Abdominal aortic screening revealed 87 anomalies (28%), of which 13 were aneurysms (maximum diameter ≥3 cm) and 74 dilatations (≥2 to <3 cm). The mean carotid IMT was 0.8±0.2 mm and was not significant enough to distinguish patients with CAD from the others. Carotid echo-Doppler imaging yielded significant plaques (≥1.5 mm) in 163 patients (53%), one internal carotid occlusion and significant stenoses (>50%) in 6 patients; two of these patients required short term surgery. Carotid imaging alone contributed to risk re-stratification of 47 patients (15.5%) from the low and intermediate risk groups to the high-risk group according to the basic PROCAM scoring system (PROspective CArdiovascular Munster study). Taking into account the presence of CAD and of diabetes mellitus, the initial cardiological examination shifted the number of high risk patients from 88 (29%) to 212 (69.9%). The three-year follow-up (96% of the initial group of patients) yielded all-cause mortality of 10%, cardiovascular mortality of 6% and non-fatal cardiovascular events of 17.5%. At three years, the therapeutic impact of the cardiological key consultation was still significant for inhibitors of the renin-angiotensin system; in men, this was the case for betablockers and statins as well. Conclusion: Screening of the abdominal aorta and carotid arteries during routine TTE was highly contributory to vascular diagnosis and to cardiovascular risk assessment and can be performed without additional cost or significant additional time.