Background: Coronary artery disease (CAD) is the leading cause of death worldwide. Previously thought to affect primarily high-income countries, CAD now leads to more death and disability in low- and middle-income countries. Aim of study: This study was conducted to respectively evaluate the carotid intima –media thickness and plaque as a predictor for ischemic etiology in patients with severe left ventricular systolic dysfunction.Methods: This study was a descriptive comparative cross-sectional study conducted at Cardiology Department in Mansoura Specialized Medical Hospital. This study was conducted on patients with severe left ventricular systolic dysfunction with estimated EF ≤ 35% undergoing coronary angiography. Results: The mean RT IMT and LT IMT were associated with a highly statically significant increase in group (1) compared to group (2) (P<0.001). In addition, positive RT plaque and positive LT plaque were significantly increase in group (1) compared to group (2) (p<0.05). Conclusion: In the context of severe left ventricular systolic dysfunction the carotid intima –media thickness and plaque could be used as promising predictors for ischemic etiology.

Carotid Intima –Media Thickness; Plaque; Ischemic; Left Ventricular Systolic Dysfunction.