New Guidelines Issued on Carotid Ultrasound for Diagnosing CAD
February 11, 2008 - The American Society of Echocardiography (ASE) has issued a new consensus statement for interpreting and responding to results of a carotid ultrasound study for cardiovascular disease risk assessment, in order to identify hidden risks for heart disease without invasive procedures.
The statement provides specific guidance for detecting early atherosclerotic plaques and increased thickness of the carotid artery walls - also known as carotid intima-media thickness (CIMT). By following the consensus statement, doctors will be more confident recommending aggressive preventive therapies if ultrasound reveals the walls of the carotid arteries are thicker than established cut points for patients of similar age, sex and race.
“There is a great interest in identifying patients who don't have symptoms of heart and blood vessel disease, but who are at higher risk than they may appear,” said James H. Stein, M.D., a cardiologist at the University of Wisconsin School of Medicine and Public Health, the lead author of the ASE consensus statement. “Having a safe, noninvasive approach for diagnosing early arterial disease and revealing potential heart disease will give doctors and patients the information they need to select the best treatment options.”
Carotid ultrasound has been used as a research tool for more than two decades and is increasingly turning into an established clinical practice. To guide doctors on when it should be used and what the results mean, the consensus statement provides standards for patient selection, scanning technique, imaging protocol and interpretation. In addition, it provides recommendations for training and certification of sonographers and readers.
Dr. Stein said despite the proven value of ultrasound scans for arteries, ASE is not recommending routine use of the procedure for all patients. “The guidelines are designed to alert physicians to the types of patients for whom the test may be useful,” he said. “Carotid ultrasound to measure wall thickness and look for early plaques is most useful when other clinical information puts patients on the borderline between needing aggressive therapy and following a more standard approach.”
Patients that may benefit from this test include those who do not already have heart or arterial disease and who:
* Are clinically determined to be at 'intermediate' risk for a heart attack or cardiac death in the next ten years
* Have a family history of premature cardiovascular disease in a close relative
* Have significant abnormalities in one or more known cardiovascular risk factors (such as young patients with genetic cholesterol disorders or who are heavy smokers
* Are women under 60 with at least two cardiovascular risk factors.
This test can be considered if the level of aggressiveness of therapy is uncertain and additional information about the burden of early vascular disease or future cardiovascular disease risk is needed. Imaging should not be performed unless the results would be expected to alter therapy. The guidelines set the 75th percentile as the threshold for aggressive treatment. Those who have CIMT greater than that level for patients of similar age, sex and race are considered to be at increased cardiovascular risk. Also, patients with carotid plaques are considered at increased risk.
The consensus panel recommended a comprehensive scan of all segments of both carotid arteries to look for the presence of plaques, as well as imaging of the far walls of each common carotid artery so CIMT can be measured. The presence of carotid plaque or increased CIMT is a marker of increased risk of heart attack, stroke, or death from cardiovascular disease.
This consensus statement was also endorsed by the Society for Vascular Medicine.
Source: The American Society of Echocardiography
For more information: www.seemyheart.org
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