Global perspective on carotid intima-media thickness and plaque: should the current measurement guidelines be revisited?
Luca Saba, Ankush D. Jamthikar, Deep Gupta, Narendra N. Khanna, Klaudija Višković, Harman S. Suri, Ajay Gupta, Sophie Mavrogeni, Monika Turk, John R. Laird, Gyan Pareek, Martin Miner, Petros P. Sfikakis, Athanasios Protogerou, George D. Kitas, Vijay Viswanathan, Andrew Nicolaides, Deepak L. Bhatt, Jasjit S. Suri
Abstract
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.