Feasibility and Applicability of Wireless Handheld Ultrasound Measurement of Carotid Intima-Media Thickness in Patients with Cardiac Symptoms

다국어 초록 (Multilingual Abstract)

Purpose: Routine screening for carotid intima-media thickness (CIMT) and cardiovascular (CV) disease in asymptomatic patientshas been criticized for the high costs and large number of patients required for detecting one patient with coronary artery disease(CAD). In order to overcome the low cost-effectiveness thereof, we investigated the feasibility of an economic wireless handheldultrasound (WHUS) device for CIMT measurement in symptomatic patients.
Materials and Methods: A total of 100 consecutive patients with cardiac symptoms were enrolled. CIMT was measured in all patients.
Coronary angiography was performed in 75 patients indicated for the exam.
Results: The mean of maximal CIMT measured from left/right common carotid artery and bulb (max-CIMT) by the WHUS deviceshowed excellent agreement [intraclass correlation coefficient (ICC)=0.960] with a standard ultrasound device and great interobserverrepeatability (ICC>0.9 between all observers). Receiver operating characteristic curve analysis showed that the predictivepower for CAD was improved when max-CIMT and plaque information (plaque≥2) was added [area under the curve (AUC):0.838] to the traditional clinical CV risk factors (AUC: 0.769). The cutoff values for CAD prediction with the standard device and theWHUS device were 1.05 mm (AUC: 0.807, sensitivity: 0.78, specificity: 0.53) and 1.10 mm (AUC: 0.725, sensitivity: 0.98, specificity:0.27), respectively.
Conclusion: max-CIMT measured by a WHUS device showed excellent agreement and repeatability, compared with standard ultrasound.
Combined max-CIMT and plaque information added predictive power to the traditional clinical CV risk factors in detectinghigh-risk CAD patients.

참고문헌 (Reference)

1 Oh NR, "Wireless mobile ultrasonography-assisted parotid duct stone removal" 97 : E36-E38, 2018

2 서종권, "Prevalence and Clinical Outcomes of Asymptomatic Carotid Artery Stenosis in Patients Undergoing Concurrent Coronary and Carotid Angiography" 연세대학교의과대학 60 (60): 542-546, 2019

3 Tse KH, "Pocket-sized versus standard ultrasound machines in abdominal imaging" 55 : 325-333, 2014

4 Dogan S, "Mean common or mean maximum carotid intima-media thickness as primary outcome in lipid-modifying intervention studies" 18 : 946-957, 2011

5 Lee SH, "Managing a seroma with wireless mobile ultrasound device" 70 : e7-e9, 2017

6 den Ruijter HM, "Long-term health benefits and costs of measurement of carotid intima-media thickness in prevention of coronary heart disease" 31 : 782-790, 2013

7 Aeshita Dwivedi, "Evaluation of Atherosclerotic Plaque in Non-invasive Coronary Imaging" 대한심장학회 48 (48): 124-133, 2018

8 Kim EY, "Educational value of pocketsized ultrasound devices to improve understanding of ultrasound examination principles and sonographic anatomy for medical student" 12 : e0185031-, 2017

9 Costanzo P, "Does carotid intima-media thickness regression predict reduction of cardiovascular events? A meta-analysis of 41randomized trials" 56 : 2006-2020, 2010

10 Bots ML, "Common carotid intima-media thickness measurements do not improve cardiovascular risk prediction in individuals with elevated blood pressure : the USE-IMT collaboration" 63 : 1173-1181, 2014

11 Polak JF, "Carotid-wall intima-media thickness and cardiovascular events" 365 : 213-221, 2011

12 Lorenz MW, "Carotid intima-media thickness progression to predict cardiovascular events in the general population(the PROGIMT collaborative project) : a meta-analysis of individual participant data" 379 : 2053-2062, 2012

13 Nambi V, "Carotid intima-media thickness and presence or absence of plaque improves prediction of coronary heart disease risk : the ARIC(Atherosclerosis Risk In Communities)study" 55 : 1600-1607, 2010

14 Øygarden H, "Carotid intima-media thickness and prediction of cardiovascular disease" 6 : e005313-, 2017

15 Zanchetti A, "Baseline values but not treatment-induced changes in carotid intima-media thickness predict incident cardiovascular events in treated hypertensive patients : findings in the European Lacidipine Study on Atherosclerosis(ELSA)" 120 : 1084-1090, 2009

16 Cao JJ, "Association of carotid artery intima-media thickness, plaques, and C-reactive protein with future cardiovascular disease and allcause mortality : the Cardiovascular Health Study" 116 : 32-38, 2007

17 최보금, "Array Comparative Genomic Hybridization as the First-line Investigation for Neonates with Congenital Heart Disease: Experience in a Single Tertiary Center" 대한심장학회 48 (48): 217-226, 2018

18 Kim J, "A longitudinal study investigating cervical changes during labor using a wireless ultrasound device" 31 : 1787-1791, 2018

19 Williams B, "2018 ESC/ESH Guidelines for the management of arterial hypertension" 39 : 3021-3104, 2018

20 Goff DC Jr, "2013 ACC/AHA guideline on the assessment of cardiovascular risk : a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines" 63 : 2935-2959, 2014