This would have been quite useful for detecting the plaque in my arteries.
http://dgnews.docguide.com/potential-ultrasound-detecting-myocardial-infarction-stroke-symptoms-arise?
A study of portable ultrasound carried out in the United States,
Canada and India has revealed the potential of this technology for
detecting plaques in peripheral arteries that can lead to myocardial
infarctions and stroke before symptoms arise, in both developed and
developing country settings, allowing preventive treatment in those
affected. The study, published in Global Heart is by Ram Bedi,
PhD, Department of Bioengineering, University of Washington, Seattle,
Washington, and Jagat Narula, MD, PhD, Icahn School of Medicine at Mount
Sinai, New York, New York, and colleagues.
Numerous research studies have shown that it is possible to assess
subclinical atherosclerotic cardiovascular disease (ASCVD) using
ultrasound imaging. Since more portable and lower cost ultrasound
devices are now entering the market, along with increased automation and
functionality, it may be possible in future to routinely examine people
with ultrasound to establish any ASCVD present before symptoms emerge,
so that future disease can be prevented, for example using medication.
In this study, ASCVD was determined using ultrasound of both the carotid
arteries and the ileofemoral arteries. The findings were conveniently
summarised in an easy to understand index called the Fuster-Narula (FUN)
Score.
Data were gathered from 4 cohorts, 2 Indian and 2 North American. In
India, a medical camp setting was used, and screening with automated
ultrasound imaging was conducted over 8 days in 941 relatively young
(mean age 44 years, 34% female) asymptomatic volunteers recruited from
the semiurban town of Sirsa (Haryana) and urban city of Jaipur
(Rajasthan) in northern India. The cohort from Sirsa was specifically
recruited because all participants had already undergone aggressive
lifestyle changes (smoking cessation, no alcohol, vegetarian diet,
physically active lifestyles, daily meditation). Radiology resident
doctors who had no prior training in vascular ultrasound were trained on
the spot to perform the ultrasound examinations.
To compare the imaging findings with traditional risk factors, 2
cohorts (481 persons) were recruited from primary care clinics in North
America (one in Richmond, Texas, the other in Toronto). As well as the
same ultrasound examinations given in the Indian cohort, comprehensive
ASCVD risk factor data was gathered from these participants, all of whom
were self-referred asymptomatic individuals (mean age 60 years, 39%
female). Data collected included cholesterol levels, blood pressure,
glucose level, weight, height, smoking and family history. These people
were attending clinics for routine health examinations in most cases.
Effectiveness of established ASCVD prevention guidelines was then
compared to results from direct imaging. Ultrasound was performed by
trained experts at each centre.
In India, ultrasound revealed plaques in at least 1 artery in almost a
quarter (24%) of those examined; 107 (11%) had plaques in only the
carotids, 70 (7%) in both the carotids and iliofemoral arteries, and 47
(5%) had plaques in only the iliofemoral arteries. If just the carotids
had been examined, 177 (19%) of the asymptomatic subjects would have
been identified with plaques; by adding the iliofemoral examination, 47
additional individuals (5% of the total) were identified with plaque.
Older age and male sex were associated with the presence of plaque both
in urban and semiurban populations (the much higher levels of smoking in
men could account for their higher risk).
Data from the American and Canadian clinics showed that 203 subjects
(42%) had carotid plaque; 166 of these (82% of those with plaque) would
not have qualified for lipid-lowering therapy such as statins under the
most widely used guidelines known as ATP III (Third Report of the Expert
Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol
in Adults [Adult Treatment Panel]) guidelines. Using the recently
published more stringent ATP IV guidelines, 67 people (1third of those
with plaque and 14% of the total United States/Canadian cohort)
individuals with carotid plaque would also have failed to qualify for
treatment.
In addition, the study revealed 34 people in the United States/Canada
setting who qualified for treatment under ATP III but did not have any
plaques, and this number increased to 81 under ATP IV (if receiving
treatment such as statins, these people could be said to be overtreated,
since no plaques were evident).
The authors say: “Our study shows that automation in ultrasound
imaging technology allows even non-expert users to rapidly evaluate the
presence of subclinical atherosclerosis in a large population. Detection
of subclinical atherosclerosis is further enhanced by inclusion of the
iliofemoral artery examination.”
They add: “It seems that plaque information from ultrasound images
may serve as a guide for initiating medical intervention regardless of
the availability or knowledge of traditional risk factors. Our results
further suggest that not only in low- and middle-income countries, but
even in the developed nations, ultrasound images may help refine
strategies for medical intervention. It might however still be too
contentious to suggest that risk factors–positive and imaging-negative
asymptomatic subjects may be spared from medical intervention.
Conversely, arguments against initiating medical intervention on risk
factors–negative and imaging-positive asymptomatic subjects become
harder to justify.”
In a linked comment published with this paper, Tasneem Z Naqvi, MD,
Mayo College of Medicine and Division of Cardiology, Scottsdale,
Arizona, adds: “This study shows that the assessment of subclinical
atherosclerosis by a portable, user-friendly bedside tool is feasible in
large populations and the technique of carotid ultrasound imaging and
IMT assessment could be adopted by novices after an 8-hour crash
course.”
She concludes: “The study by Bedi et al puts into perspective the
weakness of risk factor-based approach to identify individuals with
subclinical atherosclerosis who are more likely to develop future
cardiovascular events. The study shows that the vascular ultrasound
imaging technology is ripe and that the previously existing barriers
such as poor resolution, cumbersome protocols, need for off line
processing and need for expert performer no longer exist. The question
that this study does not address−and perhaps no study in future might−is
whether this imaging based approach would save more lives than the
risk-based approach. We need to ponder if treating nearly 50% of the
adults with statins with a risk scoring algorithm (as happens in the
United States) is more appropriate versus treating only those who have
subclinical atherosclerosis based on comprehensive and readily
available, cheap and simple screening method. This study makes a
compelling argument in favour of imaging for screening.”
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