ECHO 2013 / The Role of Vascular Imaging in Cardiovascular Risk Assessment
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“cIMT (is not) clinically useful for risk reclassification of individuals in the context of primary prevention”
“For at risk populations, cIMT may still be valid.”
European Heart Journal (2010) 31, 2041-2048
CCA and ICA IMT are independent predictors of CV events
Only ICA IMT contributed (modestly) to improved risk classification
NEJM 2011; 365:213-21
Case 2: CIMT Measurement
CIMT 0.648 mm
Above the 75th Percentile
Although FRS < 1%, CIMT measurement indicates increased CV risk
Back to Case 2
43 year old female
Family history of premature CHD
Father CABG at age 49, brother MI at age 47
No hypertension, no DM
Non-smoker
TC 192, HDL 52, LDL 122, TG 92
Framingham Risk < 1%
cIMT measurement = “increased risk”
ACCF/AHA CIMT
Recommendation
IIa – “reasonable study for cardiovascular risk assessment in asymptomatic adults at intermediate risk”
USPSTF cIMT/Plaque
Screening
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of using the nontraditional risk factors discussed in this statement to screen asymptomatic men and women with no history of coronary heart disease (CHD) to prevent CHD events. This is an I statement.
ASE Consensus Statement
Stein JH, et al. J Am Soc Echocardiogr 2008;21:93
ASE Consensus
whom to test
scanning protocol, instrumentation, display and measuring technique
requirements for training, certification, quality control for sonographers and readers
content of the report and the conclusions
no comment on how results should affect management
Who Should be Screened?
Intermediate CVD risk
FRS 6%-20% without established CHD, DM
Family history of premature CVD in first degree relative (men < 55 years, women < 65 years)
Women younger than 60 years with at least 2 CVD risk factors
Not recommended in patients with established atherosclerotic disease