ECHO 2013 / The Role of Vascular Imaging in Cardiovascular Risk Assessment
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Conceptualizing cIMT
Measures the cumulative exposure to risk factors and is an indicator of atherosclerosis
At an individual level, it reflects severity of a risk factor x time exposed (age) x susceptibility of the individual to the risk factors
Individualized response to risk factors. That response predicts risk more accurately than the presence or absence of risk factors alone.
Is cIMT clinically relevant?
Positive association between cIMT and…
CV risk factors Am J Epidemiol 1991;134:250–6.
the prevalence of CV disease Stroke 1995;26:386-391
The incidence of CV events NEJM 1999;340:14-22 
A positive association between cIMT
progression and the incidence of CV events
Ann Intern Med 1998;128:262-9
cIMT and CVD Prevalence: ARIC Study
*Adjusted for age, gender, race
Burke GL, et al. Stroke 1995;26:386-391
cIMT and CVD Incidence: CHS
CHS Study: Combined end point = MI and Stroke
CIMT Progression and Clinical CV Events
N=188
Nonsmoking Men ages 45-59
Prior
CABG
CIMT: R distal CCA far wall
RR 2.2 per 0.03 mm/year; P < 0.001
RRQ4/Q1 2.8
Hodis HN, et al. Ann Intern Med 1998;128:262-9.
∆ CIMTmax = -0.0145 mm/year
How is Plaque Defined and
Quantified?
Focal protrusion that is at least 0.5 mm or 50% greater than that of surrounding CIMT
OR
Thickness greater than 1.5 mm
Stein JH, et al.. J Am Soc Echocardiogr 2008.
Mannheim Consensus Cerebrovasc Dis 2007.