Carotid bruit for detection of hemodynamically significant carotid stenosis: The Northern Manhattan Study

Elizabeth V. Ratchford, Zhezhen Jin, Marco R. Di Tullio, Maya J. Salameh, Shunichi Homma, Robert Gan, Bernadette Boden-Albala, Ralph L Sacco, Tatjana Rundek

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Objective: The prevalence of carotid bruits and the utility of auscultation for predicting carotid stenosis are not well known. We aimed to establish the prevalence of carotid bruits and the diagnostic accuracy of auscultation for detection of hemodynamically significant carotid stenosis, using carotid duplex as the gold standard. Methods: The Northern Manhattan Study (NOMAS) is a prospective multiethnic communitybased cohort designed to examine the incidence of stroke and other vascular events and the association between various vascular risk factors and subclinical atherosclerosis. Of the strokefree cohort (n53298), 686 were examined for carotid bruits and underwent carotid duplex. Main outcome measures included prevalence of carotid bruits and sensitivity, specificity, positive predictive value, negative predictive value and accuracy of auscultation for prediction of ipsilateral carotid stenosis. Results: Among 686 subjects with a mean age of 68.2 ± 9.4 years, the prevalence of ≥60% carotid stenosis as detected by ultrasound was 2.2% and the prevalence of carotid bruits was 4.1%. For detection of carotid stenosis, sensitivity of auscultation was 56%, specificity was 98%, positive predictive value was 25%, negative predictive value was 99% and overall accuracy was 97.5%. Discussion: In this ethnically diverse cohort, the prevalence of carotid bruits and hemodynamically significant carotid stenosis was low. Sensitivity and positive predictive value were also low, and the 44% false-negative rate suggests that auscultation is not sufficient to exclude carotid stenosis. While the presence of a bruit may still warrant further evaluation with carotid duplex, ultrasonography may be considered in high-risk asymptomatic patients, irrespective of findings on auscultation.

Original languageEnglish
Pages (from-to)748-752
Number of pages5
JournalNeurological Research
Volume31
Issue number7
DOIs
StatePublished - Sep 1 2009

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Carotid Stenosis
Auscultation
Blood Vessels
Ultrasonography
Atherosclerosis
Stroke
Outcome Assessment (Health Care)
Sensitivity and Specificity
Incidence

Keywords

  • Auscultation
  • Carotid bruit
  • Carotid stenosis
  • Vascular ultrasonography

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Carotid bruit for detection of hemodynamically significant carotid stenosis : The Northern Manhattan Study. / Ratchford, Elizabeth V.; Jin, Zhezhen; Di Tullio, Marco R.; Salameh, Maya J.; Homma, Shunichi; Gan, Robert; Boden-Albala, Bernadette; Sacco, Ralph L; Rundek, Tatjana.

In: Neurological Research, Vol. 31, No. 7, 01.09.2009, p. 748-752.

Research output: Contribution to journalArticle

Ratchford, EV, Jin, Z, Di Tullio, MR, Salameh, MJ, Homma, S, Gan, R, Boden-Albala, B, Sacco, RL & Rundek, T 2009, 'Carotid bruit for detection of hemodynamically significant carotid stenosis: The Northern Manhattan Study', Neurological Research, vol. 31, no. 7, pp. 748-752. https://doi.org/10.1179/174313209X382458
Ratchford, Elizabeth V. ; Jin, Zhezhen ; Di Tullio, Marco R. ; Salameh, Maya J. ; Homma, Shunichi ; Gan, Robert ; Boden-Albala, Bernadette ; Sacco, Ralph L ; Rundek, Tatjana. / Carotid bruit for detection of hemodynamically significant carotid stenosis : The Northern Manhattan Study. In: Neurological Research. 2009 ; Vol. 31, No. 7. pp. 748-752.
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abstract = "Objective: The prevalence of carotid bruits and the utility of auscultation for predicting carotid stenosis are not well known. We aimed to establish the prevalence of carotid bruits and the diagnostic accuracy of auscultation for detection of hemodynamically significant carotid stenosis, using carotid duplex as the gold standard. Methods: The Northern Manhattan Study (NOMAS) is a prospective multiethnic communitybased cohort designed to examine the incidence of stroke and other vascular events and the association between various vascular risk factors and subclinical atherosclerosis. Of the strokefree cohort (n53298), 686 were examined for carotid bruits and underwent carotid duplex. Main outcome measures included prevalence of carotid bruits and sensitivity, specificity, positive predictive value, negative predictive value and accuracy of auscultation for prediction of ipsilateral carotid stenosis. Results: Among 686 subjects with a mean age of 68.2 ± 9.4 years, the prevalence of ≥60{\%} carotid stenosis as detected by ultrasound was 2.2{\%} and the prevalence of carotid bruits was 4.1{\%}. For detection of carotid stenosis, sensitivity of auscultation was 56{\%}, specificity was 98{\%}, positive predictive value was 25{\%}, negative predictive value was 99{\%} and overall accuracy was 97.5{\%}. Discussion: In this ethnically diverse cohort, the prevalence of carotid bruits and hemodynamically significant carotid stenosis was low. Sensitivity and positive predictive value were also low, and the 44{\%} false-negative rate suggests that auscultation is not sufficient to exclude carotid stenosis. While the presence of a bruit may still warrant further evaluation with carotid duplex, ultrasonography may be considered in high-risk asymptomatic patients, irrespective of findings on auscultation.",
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T1 - Carotid bruit for detection of hemodynamically significant carotid stenosis

T2 - The Northern Manhattan Study

AU - Ratchford, Elizabeth V.

AU - Jin, Zhezhen

AU - Di Tullio, Marco R.

AU - Salameh, Maya J.

AU - Homma, Shunichi

AU - Gan, Robert

AU - Boden-Albala, Bernadette

AU - Sacco, Ralph L

AU - Rundek, Tatjana

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N2 - Objective: The prevalence of carotid bruits and the utility of auscultation for predicting carotid stenosis are not well known. We aimed to establish the prevalence of carotid bruits and the diagnostic accuracy of auscultation for detection of hemodynamically significant carotid stenosis, using carotid duplex as the gold standard. Methods: The Northern Manhattan Study (NOMAS) is a prospective multiethnic communitybased cohort designed to examine the incidence of stroke and other vascular events and the association between various vascular risk factors and subclinical atherosclerosis. Of the strokefree cohort (n53298), 686 were examined for carotid bruits and underwent carotid duplex. Main outcome measures included prevalence of carotid bruits and sensitivity, specificity, positive predictive value, negative predictive value and accuracy of auscultation for prediction of ipsilateral carotid stenosis. Results: Among 686 subjects with a mean age of 68.2 ± 9.4 years, the prevalence of ≥60% carotid stenosis as detected by ultrasound was 2.2% and the prevalence of carotid bruits was 4.1%. For detection of carotid stenosis, sensitivity of auscultation was 56%, specificity was 98%, positive predictive value was 25%, negative predictive value was 99% and overall accuracy was 97.5%. Discussion: In this ethnically diverse cohort, the prevalence of carotid bruits and hemodynamically significant carotid stenosis was low. Sensitivity and positive predictive value were also low, and the 44% false-negative rate suggests that auscultation is not sufficient to exclude carotid stenosis. While the presence of a bruit may still warrant further evaluation with carotid duplex, ultrasonography may be considered in high-risk asymptomatic patients, irrespective of findings on auscultation.

AB - Objective: The prevalence of carotid bruits and the utility of auscultation for predicting carotid stenosis are not well known. We aimed to establish the prevalence of carotid bruits and the diagnostic accuracy of auscultation for detection of hemodynamically significant carotid stenosis, using carotid duplex as the gold standard. Methods: The Northern Manhattan Study (NOMAS) is a prospective multiethnic communitybased cohort designed to examine the incidence of stroke and other vascular events and the association between various vascular risk factors and subclinical atherosclerosis. Of the strokefree cohort (n53298), 686 were examined for carotid bruits and underwent carotid duplex. Main outcome measures included prevalence of carotid bruits and sensitivity, specificity, positive predictive value, negative predictive value and accuracy of auscultation for prediction of ipsilateral carotid stenosis. Results: Among 686 subjects with a mean age of 68.2 ± 9.4 years, the prevalence of ≥60% carotid stenosis as detected by ultrasound was 2.2% and the prevalence of carotid bruits was 4.1%. For detection of carotid stenosis, sensitivity of auscultation was 56%, specificity was 98%, positive predictive value was 25%, negative predictive value was 99% and overall accuracy was 97.5%. Discussion: In this ethnically diverse cohort, the prevalence of carotid bruits and hemodynamically significant carotid stenosis was low. Sensitivity and positive predictive value were also low, and the 44% false-negative rate suggests that auscultation is not sufficient to exclude carotid stenosis. While the presence of a bruit may still warrant further evaluation with carotid duplex, ultrasonography may be considered in high-risk asymptomatic patients, irrespective of findings on auscultation.

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KW - Carotid bruit

KW - Carotid stenosis

KW - Vascular ultrasonography

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