The Prevalence of Extra-cranial Carotid Artery Disease in Chronic Heart Failure
Nasser Sherwi *
Department of Cardiology, Hull Royal Infirmary and Castle Hill Hospital, University of Hull, Kingston Upon Hull, UK
Kenneth Wong
Department of Cardiology, Hull Royal Infirmary and Castle Hill Hospital, University of Hull, Kingston Upon Hull, UK
Jufen Zhang
Department of Cardiology, Hull Royal Infirmary and Castle Hill Hospital, University of Hull, Kingston Upon Hull, UK
Pierpaolo Pellicori
Department of Cardiology, Hull Royal Infirmary and Castle Hill Hospital, University of Hull, Kingston Upon Hull, UK
Olga Khaleva
Department of Cardiology, Hull Royal Infirmary and Castle Hill Hospital, University of Hull, Kingston Upon Hull, UK
Christos Bourantas
Department of Cardiology, Hull Royal Infirmary and Castle Hill Hospital, University of Hull, Kingston Upon Hull, UK
Azam Torabi
Department of Cardiology, Hull Royal Infirmary and Castle Hill Hospital, University of Hull, Kingston Upon Hull, UK
Andrew Clark
Department of Cardiology, Hull Royal Infirmary and Castle Hill Hospital, University of Hull, Kingston Upon Hull, UK
John G Cleland
Department of Cardiology, Hull Royal Infirmary and Castle Hill Hospital, University of Hull, Kingston Upon Hull, UK
*Author to whom correspondence should be addressed.
Abstract
Background: The prevalence of carotid disease in patients with heart failure (HF) has not been described. This may be of importance for the implementation of novel interventions for heart failure that require surgery close to the carotid artery.
Objective: The aim of this study was to determine the prevalence of extra-cranial carotid artery stenosis (ECAS) in patients with HF.
Methods: The study population comprised consecutive, patients with chronic stable HF due to left ventricular systolic dysfunction (LVSD). Patients were invited to have an ultrasound duplex scan of the internal and common extra-cranial carotid arteries (ECA) and stenoses were classified as minor if <50%, moderate if 50-69% and severe if >70%.
Results: Of 102 patients, the median age was 73 (IQR: 66-78) years and 95 were men. Ten patients had moderate ECAS of whom one also had severe ECAS in the contra-lateral artery. Thirteen patients gave a prior history of stroke or transient ischaemic attack. Of patients with ECAS, only three (30%) had had a neurological event and only three (23%) of those with a neurological event had moderate or severe ECAS (95% CI; 6-55%). Most neurological events had occurred in patients without ECAS.
Conclusion: There is a moderately high prevalence of ECAS in patients with HF. However, most patients with chronic heart failure (CHF) who have had a neurological event do not have ECAS and most patients with ECAS do not have neurological symptoms. The value of screening for and management of ECAS in patients with HF remains to be established.
Keywords: Chronic heart failure, carotid artery stenosis, duplex ultrasound