Multiterritory Arterial Ultrasound before Coronary <scp>CT</scp> Angiography

OBJECTIVES: Coronary artery disease (CAD) and peripheral artery disease share common pathophysiological mechanisms and risk factors. Early identification of individuals at risk for CAD is essential for timely diagnosis and intervention. This study evaluated whether non-coronary arterial ultrasound can improve preselection for coronary computed tomography angiography (CCTA) and provide diagnostic information beyond simplified clinical assessment. METHODS: Seventy-two patients underwent both CCTA and standardized ultrasonographic assessment of multiterritory non-coronary arterial ultrasound, including the carotid, aortoiliac, and lower-extremity arteries. The primary endpoint was CCTA-defined high-grade coronary stenosis. Atherosclerotic plaques were evaluated using a plaque-counting quantitative score, referred to as plaque score (PS), and a semi-quantitative morphology-based classification, referred to as so-called ultrasonic biopsy (UB). To explore incremental diagnostic value beyond routine clinical assessment, a simplified clinical model was compared with a multiterritory ultrasound plaque score and with a combined clinical and ultrasound model. RESULTS: Ultrasound models demonstrated high diagnostic accuracy for identifying CCTA-defined high-grade coronary stenosis, with area under the curve (AUC) values ranging from 0.87 to 0.90. Models incorporating the aortoiliac territory showed the highest sensitivity (up to 90%), whereas UB carotid (CAR) + lower extremity arteries (LEA) achieved the highest specificity (92%). In an exploratory incremental analysis, the simplified clinical model achieved an AUC of 0.864, the multiterritory plaque score alone an AUC of 0.887, and the combined model an AUC of 0.929. Addition of the ultrasound score significantly improved model fit (likelihood-ratio p < .001). CONCLUSIONS: In this exploratory cohort, ultrasound assessment of multiterritory non-coronary arterial atherosclerosis may complement routine clinical assessment and help refine patient selection for CCTA by identifying patients with a higher likelihood of high-grade coronary stenosis on CCTA.