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Backgrounds: Carotid intima media thickness(CIMT) has been used as a surrogate marker of coronary artery disease(CAD). But the relation of mechanical property of common carotid artery(CCA) with CAD have not been well clarified. This study aimed to investigate the relation of strain of CCA and CIMT in assessment of CAD.Methods:121 consecutive patients who underwent coronary angiography and CCA ultrasonography within a month were enrolled. In left CCA, circumferential strain(%) and strain rate were measured by 2-dimensional speckle tracking method and CIMT was measured at far wall distal to the bulb over a length of 1cm. Patients with known CAD and with >50% CCA stenosis were excluded. CAD was defined as >50% stenosis of major epicardial coronary artery.Results:17 patients were excluded due to inadequate image. Among 104 patients (mean age= 59 ± 11, F : M= 39 : 65), 39 patients had CAD. The values of strain and strain rate were negatively correlated with CIMT (r=-0.18, p<0.05 and r= -0.21, p<0.05), and positively correlated with the number of risk factor (p<0.05). The values of strain, strain rate were lower and CIMT were higher in CAD significantly (strain, 2.91±1.26% vs 2.23±0.84%, p=0.004, strain rate 0.44±0.17/sec vs 0.33±0.11/sec, p=0.001, CIMT 0.74±0.16mm vs 0.81±0.18mm, p=0.042, respectively). However, after adjustment for the age of patients, the significant relation with CAD were valid only in the values of strain and strain rate, not in CIMT(odds ratio, p-value : CIMT : 1.015, p=0.29, strain : 0.501, p<0.05, strain rate : 0.955, p<0.05). And, the severity of the disease assessed by the number of stenosed coronary arteries exhibited significant correlation with the values of strain and strain rate, but not with CIMT.Conclusion:Both CIMT and strain are associated with CAD. However, CAD severity and CAD extent after adjustment of age are only correlated with the values of strain and strain rate. These findings suggest that the evaluation of carotid artery mechanical properties by ultrasonographic 2D strain image could be more effective tool for the assessment of CAD than CIMT.