Cardiovascular Ultrasound Detection of Cardiovascular Disease: A Review

Cardiac & Carotid:

Unrecognized cardiac and vascular abnormalities can be detected through population based screening in up to 25% of participants.  Only ONE life time screening ECG (EKG) and ONE aortic aneurysm (AAA) screening is reimbursed by CMS.  CMS requires a physicians order and is ONLY available to men 65 to 75 who have ever smoked and if the patient has certain other discrete risk factors.

Cardiac sonography in the community setting (OUTSIDE of a hospital or classic clinic setting) has detected POOR HEART function and valve disease in about 4 to 5% of patients.  Carotid sonography has detected about 10% of patients having greater than 50% narrowing.  Generally, carotid plaque is considered "significant" when the blockage exceeds 50%.  In young adults, history ALONE detects only about 1/2 of cardiac abnormalities.  If an ECG (electrocardiogram - aka "EKG) is done, sensitivity increases to 80 to 90%.  Adding ultrasound, brings detection of serious structural abnormalities to GREATER than 96%.  

A study of 6,861 "middle" age participants undergoing standard 2D and Doppler imaging found a significant benefit in patients who had a FAMILY HISTORY of heart attack.  The ECG and the 2D echocardiogram are primary and secondary screening tools that are EXCELLENT at discovering and help manager undetected cardiac abnormalities.  

Abdominal Aneurysm Screening:

Screening for abdominal aortic aneurysm (AAA) of greater than 3.0 cm in size REDUCES the 83% MORTALITY rate of undiagnosed AAA RUPTURE.  Reimaging AAA is indicated for diameters from 4.0 to 4.9 cm in size every 1-2 years and every 3 to 6 months for aneurysms 5.0 to 5.4 cm.  (RISK FACTORS: smoking, hypertension, diabetes, long/tall/lanky body type, and first degree family history of aneurysm).

Ankle Brachial Index for PAD:

ABI testing detects flow restrictive peripheral arterial disease (PAD) and has a sensitivity of about 88% for predicting associated cardiovascular mortality such as heart attack and stroke.  Prevalence of of PAD in the general population is about 6.7% with higher rates up to 25% in patients with DIABETES, who smoke, or have hypertension or abnormal levels of certain types of cholesterol.

General Considerations:

Perhaps the most important part of the personell requirements is the requirement of credentialed staff performing studies.  National recommendations suggest that personnel performing sonography have, at a minimum, national credentials in the modality in which they are performing the image acquisition.  

 

Mark D. Zemanek, November 2018

Source article: Cardiovascular Ultrasound Combined with Non-invasive Screening for the Detection of Undiagnosed Cardiovascular Disease: A Literature Review, 2018.  Vol. 34(3)

Author
Mark Zemanek Technical Director, Vital Health Scores

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