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REVIEW  CAROTID DISEASE Editor’s choice • Free accessfree

International Angiology 2019 December;38(6):451-65

DOI: 10.23736/S0392-9590.19.04267-6


lingua: Inglese

Global perspective on carotid intima-media thickness and plaque: should the current measurement guidelines be revisited?

Luca SABA 1, Ankush JAMTHIKAR 2, Deep GUPTA 2, Narendra N. KHANNA 3, Klaudija VISKOVIC 4, Harman S. SURI 5, Ajay GUPTA 6, Sophie MAVROGENI 7, Monika TURK 8, John R. LAIRD 9, Gyan PAREEK 10, Martin MINER 11, Petros P. SFIKAKIS 12, Athanasios PROTOGEROU 13, George D. KITAS 14, Vijay VISWANATHAN 15, Andrew NICOLAIDES 16, Deepak L. BHATT 17, Jasjit S. SURI 18

1 Department of Radiology, University of Cagliari, Cagliari, Italy; 2 Department of Electronics and Communication Engineering, Visvesvaraya National Institute of Technology, Nagpur, India; 3 Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, India; 4 Department of Radiology and Ultrasound, University Hospital for Infectious Diseases, Zagreb, Croatia; 5 Brown University, Providence, RI, USA; 6 Department of Radiology, Weill Cornell Medicine, New York, NY, USA; 7 Cardiology Clinic, Onassis Cardiac Surgery Center, Athens, Greece; 8 Department of Neurology, University Medical Center Maribor, Maribor, Slovenia; 9 Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA, USA; 10 Minimally Invasive Urology Institute, Brown University, Providence, RI, USA; 11 Men’s Health Center, Miriam Hospital, Providence, RI, USA; 12 Unit of Rheumatology, National Kapodistrian University of Athens, Athens, Greece; 13 Department of Cardiovascular Prevention and Research, Clinic and Laboratory of Pathophysiology, National and Kapodistrian, University of Athens, Athens, Greece; 14 R and D Academic Affairs, Dudley Group NHS Foundation Trust, Dudley, UK; 15 MV Hospital for Diabete, Professor M Viswanathan Diabetes Research Center, Chennai, India; 16 Vascular Screening and Diagnostic Center, University of Nicosia Medical School, Nicosia, Cyprus; 17 Brigham and Women’s Hospital Heart, Vascular Center, Harvard Medical School, Boston, MA, USA; 18 Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA

Carotid intima-media thickness (cIMT) and carotid plaque (CP) currently act as risk predictors for CVD/Stroke risk assessment. Over 2000 articles have been published that cover either use cIMT/CP or alterations of cIMT/CP and additional image-based phenotypes to associate cIMT related markers with CVD/Stroke risk. These articles have shown variable results, which likely reflect a lack of standardization in the tools for measurement, risk stratification, and risk assessment. Guidelines for cIMT/CP measurement are influenced by major factors like the atherosclerosis disease itself, conventional risk factors, 10-year measurement tools, types of CVD/Stroke risk calculators, incomplete validation of measurement tools, and the fast pace of computer technology advancements. This review discusses the following major points: 1) the American Society of Echocardiography and Mannheim guidelines for cIMT/CP measurements; 2) forces that influence the guidelines; and 3) calculators for risk stratification and assessment under the influence of advanced intelligence methods. The review also presents the knowledge-based learning strategies such as machine and deep learning which may play a future role in CVD/stroke risk assessment. We conclude that both machine learning and non-machine learning strategies will flourish for current and 10-year CVD/Stroke risk prediction as long as they integrate image-based phenotypes with conventional risk factors.

KEY WORDS: Ultrasonography; Carotid arteries; Cardiovascular diseases; Stroke

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