ICBU looking better and better.
Medical DD on PCI heartscan:
Evidence mounting from leading medical journals and the MAYO Clinic regarding (CIMT) (PCI Heartscan) and inclusion into standard screening protocols. Going forward, we could see this adopted into new preventative screening techniques with inclusion in the Healthcare Bill/Medicare!!!!!!!!!!!
iMD may be jumping on a nice first mover advantage here...
Could be a huge home run here....grabbed a chunk today!!! ;)
Mayo Clin Proc. 2009 Mar;84(3):229-33.
Carotid intima-media thickness and coronary artery calcium score as indications of subclinical atherosclerosis.
Lester SJ, Eleid MF, Khandheria BK, Hurst RT.
Division of Cardiovascular Diseases, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA. lester.steven@mayo.edu
Abstract
OBJECTIVE: To determine the ability of carotid intima-media thickness (CIMT) and coronary artery calcium score (CACS) to detect subclinical atherosclerosis in a young to middle-aged, low-risk, primary-prevention population.
PATIENTS AND METHODS: Patients aged 36 to 59 years who underwent determination of CIMT and CACS at our institution between May 1, 2004, and April 1, 2008, were included in the study. Those with diabetes mellitus or a history of coronary, peripheral, or cerebral vascular disease were excluded. Other information, such as Framingham risk score (FRS), was obtained by a review of clinical and laboratory data.
RESULTS: Of 118 patients, 89 (75%) had a CACS of zero and 94 (80%) were men; mean +/- SD age was 48.9+/-5.7 years. The mean FRS of this group was 4.0; 86 patients (97%) were considered at low risk (<1% annualized rate) of cardiovascular events. Evidence of carotid atherosclerosis was found in 42 (47%; 95% confidence interval, 37%-58%) of these 89 patients; carotid plaque was found in 30 (34%); and CIMT above the 75th percentile was found in 12 (13%) of age-, sex-, and race-matched control patients. Of the 40 patients with low-risk CIMT (below the 50th percentile), 4 (10%) had a CACS at or above the 50th percentile.
CONCLUSION: Subclinical vascular disease can be detected by CIMT evaluation in young to middle-aged patients with a low FRS and a CACS of zero. These findings have important implications for vascular disease screening and the implementation of primary-prevention strategies.
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J Am Soc Echocardiogr. 2010 Aug;23(8):809-15. Epub 2010 May 31.
High prevalence of ultrasound detected carotid atherosclerosis in subjects with low Framingham risk score: potential implications for screening for subclinical atherosclerosis.
Naqvi TZ, Mendoza F, Rafii F, Gransar H, Guerra M, Lepor N, Berman DS, Shah PK.
Cardiac Non Invasive Laboratory, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. tnaqvi@usc.edu
Abstract
BACKGROUND: The cardiovascular (CV) risk assigned by the Framingham risk score (FRS) misses many subjects destined for CV events. Coronary artery calcification (CAC) as measured by computed tomography and carotid intima-media thickness (CIMT) and plaque assessment using B-mode ultrasound can identify subclinical atherosclerosis. The comparative relation of CAC and CIMT and carotid plaque after integration into the FRS is not established. The aim of this study was to develop a CV screening approach incorporating FRS, CAC, and CIMT.
METHODS: The prevalence of subclinical atherosclerosis, defined as CAC score > 0, CIMT > or = 75th percentile, or plaque > or = 1.5 mm, was determined in the groups with low, intermediate, and high FRS among 136 asymptomatic subjects. The CIMT and CAC values were used to determine "vascular age" and "coronary calcium" age, respectively, with established nomograms.
RESULTS: In the 103 low-risk (FRS < 10%) subjects, 41%, 50%, 59%, and 66% had CAC scores > 0, CIMT > or = 75th percentile, plaque > or = 1.5 mm, and CIMT > or = 75th percentile or plaque > or = 1.5 mm, respectively. In the 33 subjects with intermediate (n = 14) or high (n = 19) FRS, 70%, 81%, 87%, and 87% had CAC scores > 0, CIMT > or = 75th percentile, plaque > or = 1.5 mm, and CIMT > or = 75th percentile or plaque > or = 1.5 mm, respectively. Fifty-two percent of subjects with coronary calcium scores of zero had carotid plaque. Adjusted for FRS, body mass index was an independent predictor of abnormal CIMT in the low-FRS group, but not of abnormal CAC. Mean vascular CIMT age was significantly higher than coronary calcium age (61.6 + or - 11.4 vs 58.3 + or - 11.1 years, P = .001), and both were significantly higher than chronologic age (56.9 + or - 10.1 years) (P < .0001 and P < .04, respectively). CIMT upgraded or downgraded FRS by >5% in more cases than CAC (42% vs 17%).
CONCLUSION: In asymptomatic patients without CV disease, CIMT and plaque assessment are more likely to revise FRS than CAC.
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Nice conclusion from American Journal of Cardiology 2009--
Am J Cardiol. 2009 Oct 15;104(8):1041-6.
Usefulness of carotid intima-media thickness in patients with diabetes mellitus as a predictor of coronary artery disease.
Djaberi R, Schuijf JD, de Koning EJ, Rabelink TJ, Smit JW, Kroft LJ, Pereira AM, Scholte AJ, Spaans M, Romijn JA, de Roos A, van der Wall EE, Jukema JW, Bax JJ.
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Abstract
Identification of asymptomatic patients with diabetes mellitus (DM) at increased risk for coronary artery disease (CAD) remains a challenge. Carotid intima-media thickness (CIMT) has been proposed as a surrogate marker for CAD but only limited data are available. The purpose of the study was to evaluate the potential of CIMT for prediction of CAD in asymptomatic patients with DM. Prospectively, CIMT of the left and right common carotid arteries was assessed by B-mode ultrasound in 150 asymptomatic diabetic patients (50 +/- 13 years old, 83 men). In addition, noninvasive multislice computed tomographic coronary angiography was performed to relate CIMT to the presence and severity of CAD. For this purpose, patients were classified as having (1) no atherosclerosis, (2) nonobstructive atherosclerosis, or (3) obstructive stenosis with >or=50% luminal diameter narrowing. Mean CIMT increased significantly from 0.58 +/- 0.08 mm in patients with normal coronary arteries (n = 59, 39%) to 0.67 +/- 0.12 mm in patients with nonobstructive atherosclerosis (n = 54, 36%). Highest mean CIMT (0.75 +/- 0.12 mm) was observed in patients with obstructive stenosis (n = 36, 25%, p <0.01). Receiver operating characteristics curve analysis yielded a sensitivity and specificity of 85% and 72%, respectively, with a CIMT cut-off value of 0.67 mm, for predicting obstructive coronary atherosclerosis. Multivariate analysis of baseline risk factors showed CIMT to be an independent predictor of any and obstructive atherosclerosis (p <0.01). In conclusion, a significant relation was shown between CIMT and the presence and severity of CAD in asymptomatic patients with DM. Assessment of CIMT may be useful to identify diabetic patients at higher risk for CAD.
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Am J Cardiol. 2009 Nov 15;104(10):1383-8. Epub 2009 Sep 26.
Screening for subclinical coronary artery disease measuring carotid intima media thickness.
Nguyen-Thanh HT, Benzaquen BS.
Division of Cardiology, Hôpital Maisonneuve Rosemont, University of Montreal, Montreal, Quebec, Canada.
Abstract
Traditional coronary risk assessment is based on major cardiovascular risk factors using the Framingham risk score. Carotid intima-media thickness (CIMT) measured by ultrasonography is a noninvasive test used to assess for the presence of coronary atherosclerosis. CIMT has been shown to be an independent predictor of future cardiovascular events and is used in research trials as a surrogate for the presence as well as regression of coronary artery disease. The objectives of this report are to review the published reports on CIMT and to help establish the role of CIMT as a screening tool for coronary artery disease in selected patients. CIMT measurement can modify cardiovascular risk prediction in patients initially classified with the Framingham risk score, with reclassification into higher or lower risk categories. It is most useful for refining risk assessment in patients at intermediate risk. The Screening for Heart Attack Prevention and Education (SHAPE) Task Force recommends screening all asymptomatic middle-aged and older men and women using noninvasive imaging. The American Society of Echocardiography established a consensus on the methodologic aspects of CIMT measurement. Sequential scanning of CIMT to assess atherosclerosis is currently not recommended, because of interscan variability and small expected changes over time. In conclusion, in the primary prevention of coronary artery disease, CIMT measurement reclassifies patients into higher or lower risk categories, allowing early appropriate management.
