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

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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 (a) use cIMT/CP or alterations of cIMT/CP and (b) 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 (i) tools for measurement, (ii) risk stratification, and (iii) risk assessment. Guidelines for cIMT/CP measurement are influenced by major factors like the (i) atherosclerosis disease itself, (ii) conventional risk factors, (iii) 10-year measurement tools, (iv) types of CVD/Stroke risk calculators, (v) incomplete validation of measurement tools, and (vi) the fast pace of computer technology advancements. This review discusses the following major points: (a) the American Society of Echocardiography (ASE) and Mannheim guidelines for cIMT/CP measurements, (b) forces that influence the guidelines, and (c) 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 (ML) 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.