Table 1

Summary of techniques for the detection of subclinical atherosclerosis

Coronary angiographyInvasive and relatively insensitive (does not detect minor stenosis due to unstable plaque)3
Intracoronary ultrasonographySensitive and detects plaque. Invasive and not practical for screening3
EchocardiographyNon-invasive but not sensitive. Detects left ventricular hypertrophy, a strong risk factor for adverse outcome11,3
Coronary perfusionThallium perfusion studies and dual isotope myocardial perfusion imaging (DIMPI): relatively insensitive and may underestimate the prevalence of atherosclerosis3,15,40
Electron beam computed tomography (EBCT)Non-invasive and accurate; detects calcified plaque, a marker of future cardiac events. Useful only in clinical trials; involves radiation3,40
Magnetic resonance imagingLimited resolution owing to cardiac motion3,40
B mode ultrasoundNon-invasive, detects subclinical carotid plaque and intima-media wall thickness. Accurate and reliable but is operator dependent3,40
Myocardial SPECT scanPerformed after treadmill exercise or dipyridamole stress. Not always concordant with carotid duplex-ascertained plaque15
Transcranial DopplerMicroembolic signals on transcranial Doppler ultrasonography are correlated with atherosclerotic disease9
Vascular stiffnessAortic pulse wave velocity (PWV) is an early marker of atherosclerotic risk. Has been used in SLE3,40
Endothelial functionFlow mediated dilatation measures the brachial artery in response to reactive hyperaemia.3,14,29 Not yet widely used in routine clinical practice