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Carotid IMT Measurement
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What is CIMT?
CIMT stands for Carotid Intima Media Thickness and refers to the combined thickness of the inner two layers (intima and media) of the carotid artery, which lies in the neck.
What does the thickness of the arterial wall (IMT) indicate?
Genetics and environmental factors (including diet, exposure to pro-atherosclerotic substances such as cigarette smoke, and physical inactivity/lack of exercise) combine over time to cause inflammation of the inner layers of the artery and the formation of plaque on the inner lining of the arterial wall. The process of plaque formation is known as atherosclerosis. This thickening can be measured using ultrasound and sophisticated edge-detection software to quantify the amount of disease present. The measurement of the thickness of the intima and media layers of the common carotid artery is predictive of future events (i.e. stroke, myocardial infarction, and heart attack).
How can CIMT be measured?
CIMT can be measured using ultrasound technology. It is a painless, noninvasive test that can be performed easily in the physician's office. The CIMT scan is brief (potentially as short as 5 minutes), does not require the patient to disrobe, is noninvasive (no needles), and does not expose the patient to radiation. It is relatively inexpensive and provides valuable information about an individual's risk of experiencing a heart attract, stroke, or MI.

If you are using a CardioHealth® Station, the CIMT measurement will be accurately and automatically performed by the system’s advanced software algorithms. The CIMT result and report will be available immediately following completion of the test.
What information does the CIMT test provide?

Multiple studies indicate that CIMT measurement detects the presence or absence of atherosclerotic disease and also allows for assessment of the degree of atherosclerotic burden better than other noninvasive cardiovascular tests available. It is recommended by both the American Heart Association and the American College of Cardiology.

The carotid ultrasound scanning procedure:


  • Can help assess the risk of future cardiac and cerebrovascular events.

  • Allows earlier detection and intervention

  • Allows more accurate risk stratification in asymptomatic patients than do traditional risk factors

  • Can also provide information about the presence or absence of visualized carotid plaque

How long has CIMT testing been used in clinical practice?
CIMT testing has been used in research for over 20 years. It has only been available in clinical settings since 2002. CIMT testing has been validated in many published studies in the most reputable journals. CIMT has been used in large epidemiologic trials as well as large outcome studies as a surrogate end point for clinical events. CIMT is probably the most studied methodology used to assess large numbers of patients in epidemiologic studies to determine either the correlation of Carotid Intima Media Thickening to clinical events or the correlation of CIMT to other known risk factors. There is a high correlation between the disease found in this procedure and the disease found through pathology samples. The amount of disease found in the common carotid artery correlates highly to the amount of disease found elsewhere in the body, including in the coronary vasculature.
How accepted is this test in clinical practice?
In the November 2010 updated guidelines for assessment of cardiovascular risk in asymptomatic adults, the American College of Cardiology Foundation/American Heart Association Task Force gave carotid intima-media thickness on ultrasound a Class IIa recommendation. “Measurement of carotid artery IMT is reasonable for cardiovascular risk assessment in asymptomatic adults at intermediate risk.”

The American Heart Association recommends this test for all patients over 45 years of age, and younger if the patient has multiple risk factors (Family History, Hyperlipidemia, Dyslipidemia, Hypertension, Metabolic Syndrome etc). As previously noted, patients that are believed to be at intermediate risk for heart disease and stroke are ideal candidates for this procedure. At its annual Prevention Conference V, the American Heart Association concluded that "Carotid artery B-mode ultrasound imaging is a safe, noninvasive, and relatively inexpensive means of assessing subclinical atherosclerosis. The technique is a valid and reliable means of measuring IMT, an operational measure of atherosclerosis. The severity of carotid IMT is an independent predictor of transient cerebral ischemia, stroke, and coronary events such as MI. In asymptomatic persons > 45 years old, carefully performed carotid ultrasound examination with IMT measurement can add incremental information to traditional risk factor assessment."

In July of 2003, Dr. Pam Douglas, President of the American College of Cardiology at the time, recommended CIMT as an effective screening tool. This recommendation was based on the following facts: 1) CIMT is highly predictive for presence of coronary and cerebral disease. 2) It is highly predictive for the development of stroke, TIA and heart attack. 3) The relationship of carotid disease to disease of the coronaries is the same as one coronary to another. 4) Carotid IMT has the most data as a diagnostic tool for arteriosclerosis. (Transcript ACCEL interview - July 2003)

The test has been cleared by the Food and Drug Administration (FDA). Also, you should note that while numerous ultrasound systems are available, the CardioHealth® Station is the only FDA-cleared, automated, real time system for measurement of CIMT.

Leading physicians across the country have added CIMT to their primary prevention as an initial risk assessment tool and as a secondary prevention tool to monitor the affect of prescribed treatment over time. Unlike coronary calcium scoring, CIMT can show disease regression.

CIMT testing has been shown to provide incremental additional data to risk prediction and is the only imaging test which has been recommended by the American Heart Association for that purpose.
Can CIMT testing also be utilized to monitor progression or regression of atherosclerotic disease?
Testing over time can shed light on the efficacy of treatment by tracking thickening (progression) or thinning (regression) of the intima media thickness. Change in plaque area and size can also be visualized.
How long does it take to complete CIMT testing of one patient?
Unlike conventional CIMT testing, the CardioHealth® Test can be completed in a single step. Other systems require a 2-step procedure: 1) First, a sonographer takes sonographic images, and 2) second, sends them to a separate software program or to an external reading service, where the ultrasound images are analyzed and the CIMT measurement is performed. With the CardioHealth® Station, the CIMT measurement is obtained automatically and the results are available as soon as the scanning procedure is completed.

In general, the test will take about 10 minutes of the patient's time to complete, but testing can often be completed more quickly. The patient is not required to disrobe and the procedure is well tolerated.
Are there any special requirements for a patient prior to having a CardioHealth® test?
There are no special requirements.
Why is this testing important for my patient?
Despite advances in patient education, cardiovascular disease remains the #1 killer in our population. Estimates indicate that with the increasing incidence of Metabolic Syndrome and Diabetes, morbidity and mortality may increase over the next 20 years. Even though there has been some improvement in cardiovascular disease assessment and intervention in men, there has been little progress regarding the detection and prevention of cardiovascular disease in women.

As many as 50% of those who died from heart attacks or strokes had no previous signs or symptoms. This test allows early intervention and prevention of disease which has the potential to catch more of these patients so they can be treated before they experience an event. In fact, some studies have shown that showing these patients their test results may help to improve their adherence to prescribed treatments.

Traditional risk factors such as cholesterol and blood pressure may be misleading. As many as 50% of those who died from heart attacks or strokes had normal "lipid" profiles. Carotid IMT will catch more people with disease who may have been shown to be normal on other tests like stress echo, standard lipid panels, and other blood/urine screens.

Carotid ultrasound scanning with CIMT measurement is a cost effective diagnostic tool which provides health value and saves lives.
How accurate is CIMT as a predictive tool?
CIMT is more accurate in predicting disease than any other risk factor alone. CIMT measurement is an independent risk factor even in the absence of any other identifiable risk factors.

Studies have shown a high (>90%) correlation between atherosclerotic disease found in the common carotid and disease found elsewhere in the body, such as in the coronary arteries that supply the heart muscle. There is a very high correlation between the thickness of the intima media and other risk factors. Perhaps most important is CIMT's correlation and ability to predict coronary and cerebral events.

CIMT has been shown in large-scale, prospective studies (ARIC Study, MESA Study, others) to be an independent predictor of heart attack and stroke. Moreover, CIMT and presence/absence of carotid plaque provide the most incremental predictive value over traditional risk factors alone.
What are the benefits of using the Panasonic CardioHealth® Station instead of utilizing an outside reading service?
  • The CardioHealth® Station is the only FDA-cleared, automated, real time system for measurement of CIMT.

  • You can manage your own testing schedule. No need to schedule all CIMT studies on a certain date.

  • You or your medical staff can be trained to measure CIMT. No need to employ and train a sonographer.

  • Extensive training and clinical resources are available.

  • As a CardioNexus client, you will have access to education and marketing materials designed specifically for your patients.