Original article
Use of Hand-held Ultrasound by a Nonsonographer Clinician to Measure Carotid Intima-Media Thickness

https://doi.org/10.1016/j.echo.2006.04.038Get rights and content

Objective

We sought to evaluate the accuracy of carotid intima-media thickness (CIMT) measurements by a nonsonographer clinician using hand-held ultrasound (HHU).

Background

Use of a HHU for point-of-care CIMT measurement has not been tested previously.

Methods

Participants underwent reference ultrasound and HHU studies. HHU validity was tested by an expert sonographer. Nonsonographer clinician accuracy using the HHU was tested against the expert sonographer. CIMT bioequivalence was tested with .5 pixel limits.

Results

The 75 participants were (mean [SD]) 55 [7] years old. CIMT values were bioequivalent (0.714 [0.029] vs 0.685 [0.029] mm, phase I; 0.697 [0.015] vs 0.687 [0.015] mm, phase II; Ptwo 1-sided t test < .05). Agreement was 80% for CIMT classifications (intraclass correlation coefficient = 0.451, P < .001) and 90% for plaque presence (intraclass correlation coefficient = 0.797, P < .001).

Conclusions

CIMT measured by HHU was bioequivalent to a reference ultrasound system, when used by an expert sonographer or nonsonographer clinician. Clinical classifications by CIMT quartile and plaque presence were similar. HHU may be suitable for office-based atherosclerosis screening.

Section snippets

Participant Characteristics

Our institutional review board approved this study. Participants were asymptomatic adults aged 40 to 75 years, without known CV disease, who were referred by their physicians to our vascular health screening program for clinical measurement of CIMT. Participants were enrolled consecutively from November 2004 to April 2005.

Results from clinically obtained, fasting blood samples were obtained. Fasting plasma glucose, serum total cholesterol, triglyceride, and high-density lipoprotein cholesterol

Participant Characteristics

Baseline characteristics are shown in the Table. Among 75 participants (mean [SD] age 55 [7] years), 55% were female, and 95% were white. Systolic blood pressure was 130 (17) mm Hg with 36% of participants taking blood pressure–lowering medications. Nearly half (47%) were taking lipid-lowering therapy. Composite CIMT using the REF system was 0.716 (0.146) mm. Participants in phase II had higher composite CIMT values than participants in phase I, and fewer were on blood pressure–lowering therapy

Discussion

This study demonstrated that CCA CIMT and determination of plaque presence from images obtained using the HHU system were similar to those obtained on a standard REF system. It also showed that a NSC can be trained to obtain images of good enough quality for CIMT measurement using the HHU system, and that CIMT measurements and plaque presence determined by the NSC using the HHU system were similar to those of an EXP using a REF system.

This is the first study to validate the use of a HHU device

References (25)

  • G. Burke et al.

    Arterial wall thickness is associated with prevalent cardiovascular disease in middle-aged adults: the atherosclerosis risk in communities (ARIC) study

    Stroke

    (1995)
  • L.E. Chambless et al.

    Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the atherosclerosis risk in communities (ARIC) study, 1987-1993

    Am J Epidemiol

    (1997)
  • Cited by (0)

    Supported in part by the National Center for Research Resources (RR-1617601); the National Heart, Lung, and Blood Institute (HL-07936); and Sonosite Inc.

    View full text