Summary of techniques for the detection of subclinical atherosclerosis
| Coronary angiography | Invasive and relatively insensitive (does not detect minor stenosis due to unstable plaque)3 |
| Intracoronary ultrasonography | Sensitive and detects plaque. Invasive and not practical for screening3 |
| Echocardiography | Non-invasive but not sensitive. Detects left ventricular hypertrophy, a strong risk factor for adverse outcome11,3 |
| Coronary perfusion | Thallium 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 imaging | Limited resolution owing to cardiac motion3,40 |
| B mode ultrasound | Non-invasive, detects subclinical carotid plaque and intima-media wall thickness. Accurate and reliable but is operator dependent3,40 |
| Myocardial SPECT scan | Performed after treadmill exercise or dipyridamole stress. Not always concordant with carotid duplex-ascertained plaque15 |
| Transcranial Doppler | Microembolic signals on transcranial Doppler ultrasonography are correlated with atherosclerotic disease9 |
| Vascular stiffness | Aortic pulse wave velocity (PWV) is an early marker of atherosclerotic risk. Has been used in SLE3,40 |
| Endothelial function | Flow mediated dilatation measures the brachial artery in response to reactive hyperaemia.3,14,29 Not yet widely used in routine clinical practice |