Association of carotid atherosclerotic disease on ultrasound with functionally relevant coronary artery disease: a prospective cohort study, a subanalysis of BASEL VIII
- 1Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Heart Center, University Hospital Basel, University of Basel, Basel, Switzerland
- 2Interventional Radiology, Cleveland Clinic, Cleveland, OH, USA
- 3Department of Angiology, University Hospital Basel, University of Basel, Basel, Switzerland
Abstract
Background: Atherosclerosis is a systemic disease underlying coronary artery disease (CAD), and carotid atherosclerosis may serve as an accessible marker of systemic atherosclerotic burden. However, the diagnostic and prognostic relevance of carotid plaque characteristics in patients with suspected functionally relevant coronary artery disease (fCAD) remains uncertain. We aimed to investigate the association of carotid atherosclerotic plaque burden and morphology with fCAD and to evaluate the prognostic value of carotid plaque characteristics for future cardiovascular events.
Methods: This prospective diagnostic subanalysis of the BASEL VIII cohort included 430 consecutive patients evaluated for suspected fCAD at the University Hospital Basel, Switzerland, between October 2011 and February 2016. fCAD was determined by myocardial perfusion imaging using single-photon emission computed tomography, supplemented by coronary angiography and fractional flow reserve measurements when available. Carotid ultrasound and contrast-enhanced ultrasound (CEUS) were performed at enrollment to assess plaque presence, burden, stenosis severity, echogenicity, and intraplaque neovascularization. Diagnostic performance was evaluated using receiver operating characteristic analysis. Major adverse cardiovascular events (MACE), comprising non-fatal myocardial infarction, stroke, and cardiovascular death, were assessed during long-term follow-up using Kaplan-Meier analysis and Cox proportional hazards regression.
Results: The study included 430 patients with suspected fCAD, of whom 105 (24.4%) were women. fCAD was confirmed in 136 patients (31.6%). Patients with fCAD more frequently exhibited carotid plaques than those without fCAD (78.7% vs. 68.0%, P=0.02). However, plaque burden, stenosis severity, plaque echogenicity, and intraplaque neovascularization were not significantly associated with fCAD. During 8 years of follow-up, 30 patients (7.0%) experienced non-fatal myocardial infarction, 17 (4.0%) suffered stroke, and 34 (7.9%) died from cardiovascular causes. The presence of carotid atherosclerotic disease was significantly associated with a higher risk of MACE [hazard ratio (HR) 2.69, 95% confidence interval (CI): 1.33–5.45]. This association remained significant after adjustment for cardiovascular risk factors and fCAD (HR 2.14, 95% CI: 1.09–4.42). In contrast, plaque morphology characteristics, including echogenicity and intraplaque neovascularization, did not provide additional diagnostic or prognostic value.
Conclusions: The presence of carotid atherosclerotic plaques was associated with fCAD and with an increased risk of future cardiovascular events in patients evaluated for suspected fCAD. However, carotid plaque burden, stenosis severity, echogenicity, and intraplaque neovascularization do not appear to improve the identification of fCAD or the prediction of long-term cardiovascular outcomes. In clinical practice, carotid plaque presence may provide complementary information on systemic atherosclerotic burden, whereas advanced carotid plaque characterization does not appear to add clinically relevant diagnostic or prognostic information in this patient population.
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BibTeX
@article{isayeva2026association,
title = {{Association of carotid atherosclerotic disease on ultrasound with functionally relevant coronary artery disease: a prospective cohort study, a subanalysis of BASEL VIII}},
author = {Ganna Isayeva and Ibrahim Schäfer and Jinju Elavathingal and Bojana Filipovic and Klara Rumora and Sasan Partovi and Markus Aschwanden and Stephan Imfeld and Pedro Lopez-Ayala and Ivo Strebel and Gabrielle Huré and Zsofia Bartha and Michael J. Zellweger and Christian Mueller and Daniel Staub},
journal = {Cardiovascular Diagnosis and Therapy},
year = {2026},
month = oct,
doi = {10.21037/cdt-2026-0353},
url = {https://doi.org/10.21037/cdt-2026-0353},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Association of carotid atherosclerotic disease on ultrasound with functionally relevant coronary artery disease: a prospective cohort study, a subanalysis of BASEL VIII
AU - Ganna Isayeva
AU - Ibrahim Schäfer
AU - Jinju Elavathingal
AU - Bojana Filipovic
AU - Klara Rumora
AU - Sasan Partovi
AU - Markus Aschwanden
AU - Stephan Imfeld
AU - Pedro Lopez-Ayala
AU - Ivo Strebel
AU - Gabrielle Huré
AU - Zsofia Bartha
AU - Michael J. Zellweger
AU - Christian Mueller
AU - Daniel Staub
PY - 2026
DA - 2026/10/22
JO - Cardiovascular Diagnosis and Therapy
DO - 10.21037/cdt-2026-0353
UR - https://doi.org/10.21037/cdt-2026-0353
AB - Background: Atherosclerosis is a systemic disease underlying coronary artery disease (CAD), and carotid atherosclerosis may serve as an accessible marker of systemic atherosclerotic burden. However, the diagnostic and prognostic relevance of carotid plaque characteristics in patients with suspected functionally relevant coronary artery disease (fCAD) remains uncertain. We aimed to investigate the association of carotid atherosclerotic plaque burden and morphology with fCAD and to evaluate the prognostic value of carotid plaque characteristics for future cardiovascular events. Methods: This prospective diagnostic subanalysis of the BASEL VIII cohort included 430 consecutive patients evaluated for suspected fCAD at the University Hospital Basel, Switzerland, between October 2011 and February 2016. fCAD was determined by myocardial perfusion imaging using single-photon emission computed tomography, supplemented by coronary angiography and fractional flow reserve measurements when available. Carotid ultrasound and contrast-enhanced ultrasound (CEUS) were performed at enrollment to assess plaque presence, burden, stenosis severity, echogenicity, and intraplaque neovascularization. Diagnostic performance was evaluated using receiver operating characteristic analysis. Major adverse cardiovascular events (MACE), comprising non-fatal myocardial infarction, stroke, and cardiovascular death, were assessed during long-term follow-up using Kaplan-Meier analysis and Cox proportional hazards regression. Results: The study included 430 patients with suspected fCAD, of whom 105 (24.4%) were women. fCAD was confirmed in 136 patients (31.6%). Patients with fCAD more frequently exhibited carotid plaques than those without fCAD (78.7% vs. 68.0%, P=0.02). However, plaque burden, stenosis severity, plaque echogenicity, and intraplaque neovascularization were not significantly associated with fCAD. During 8 years of follow-up, 30 patients (7.0%) experienced non-fatal myocardial infarction, 17 (4.0%) suffered stroke, and 34 (7.9%) died from cardiovascular causes. The presence of carotid atherosclerotic disease was significantly associated with a higher risk of MACE [hazard ratio (HR) 2.69, 95% confidence interval (CI): 1.33–5.45]. This association remained significant after adjustment for cardiovascular risk factors and fCAD (HR 2.14, 95% CI: 1.09–4.42). In contrast, plaque morphology characteristics, including echogenicity and intraplaque neovascularization, did not provide additional diagnostic or prognostic value. Conclusions: The presence of carotid atherosclerotic plaques was associated with fCAD and with an increased risk of future cardiovascular events in patients evaluated for suspected fCAD. However, carotid plaque burden, stenosis severity, echogenicity, and intraplaque neovascularization do not appear to improve the identification of fCAD or the prediction of long-term cardiovascular outcomes. In clinical practice, carotid plaque presence may provide complementary information on systemic atherosclerotic burden, whereas advanced carotid plaque characterization does not appear to add clinically relevant diagnostic or prognostic information in this patient population.
SN - 2223-3652
SN - 2223-3660
ER -