1
INTIMA MEDIA THICKNESS AND ATHEROSCLEROSIS
Michele CAZAUBON, MD, PhD
American Hospital of Paris ( France)
2
INTIMA MEDIA THICKNESS AND ATHEROSCLEROSIS
ATHEROSCLEROSIS = ARTERIAL WALL DISEASE
CLINICAL MANIFESTATIONS WHEN ADVANCED
IMPORTANCE OF SCREENING FOR PRECLINICALSTAGE
3
DOPPLER ULTRASOUND IMAGINGDOPPLER ULTRASOUND IMAGING AND ARTERIAL WALLAND ARTERIAL WALL
PLAQUE•GRADE %•ECHOGENICITY
INTIMA-MEDIATHICKNESS (IMT)
4
ANATOMICAL AND HISTOLOGY STUDY
NORMAL ARTERIAL WALL IN B.MODE ULTRASOUND
•11stst ECHOGENIC LINEA ECHOGENIC LINEA = =• LUMEN/INTIMA INTERFACELUMEN/INTIMA INTERFACE•2nd ECHOGENIC LINEA =
•/ MEDIAL / ADVENTITIAL
• PIGNOLI ( Circulation 1986)
5
IMT & ATHEROSCLEROSIS
E= IMT D = DIAMETER Nb = NB OF Points 212/1cm
6
NORMAL VALUES IMT
•0,36 mm TO 0, 90mm = NORMAL VALUE IMT FOR ADULTS
•AT THE SAME AGE : IMT > MEN / WOMEN
LINEARLY WITH AGE :0,08 mm/year
•(SALONEN AND SALONEN ATHEROSCLEROSIS 1990 )
7
•FEASABILITY OF MEASURE
•1/ CAROTID ARTERY•DISTAL COMMON CAROTID = 99% > BIFURCATION AND INTERNAL CAROTID
8
IMT AND « CLASSICAL »RISK FACTORS
AGEGENDER SMOKING
HIGH BLOOD PRESSURECHLOL AND DIABETE
9
NEW RISK FACTORS /1
1
1/HYPERHOMOCYSTEINEMIA
ASAP ( Antioxidant Supplementation in
Atherosclerosis Prevention study )-EIM dans groupe avec HC
(SALONEN ANN MED INT 1998)
10
NEW RISK FACTORS /2
2/ STANDING AT WORK PROGRESSION = 0,08 to 0,67mmbetween men standing at work NEVER / ALWAYS.
(SALONEN Environ Health 2000)
11
IMT & ATHEROSCLEROSIS
NEW RISK FACTORS
2/ STANDING AT WORK • « REDUCING THE DURATION OF STANDING AT WORK SHOULD BE
CONSIDERED IN THE PRIMARY PREVENTION OF ATHEROSCLEROSIS »
(SALONEN Environ Health 2000)
12
IMT = SENSITIVE INDICATOR FOR THE PRESENCE OF PLAQUEIN THE BIFURCATION OF COMMON CAROTID
EVA ’ STUDY ( Broussais .1996. 100 sujets 4 years follow up)
13
IMT c AND CAROTID STENOSIS
CORRELATIONBETWEEN IMT c AND
SEVERITY ATHEROSCLERIS
14
ASSOCIATION BETWEEN IMT AND PREVALENCEOF PLAQUES
BASELINE IMT - CCA IS AN INDEPENDANT PREDICTOR OF CAROTID PLAQUE OCCURRENCE
INCREASED WALL THICKNESS PRECEDE PLAQUE FORMATION
15
IMT & CAROTID ATHEROSCLEROSIS
•ROTTERDAM STUDY :
RISK ATHEROSCLEROTIC PLAQUES IN THE BIF CAR
X6 between IMT 0,63 mm / IMT 0,89 mm
(1996 . 7983 subjects population based study . GRADE B )
16
C IMT
MYOCARDIAL INF. STROKE 1/ INCLUSION =• 4476 SUBJETCS > 65 YEARS•WITHOUT CARDIO VASCULAR DISEASE•INCLUSION IMT measured : CC and Cint. = 5 QUINTILES
2/ FOLLOW UP = 6,2 YEARS
O ’LEARY et col. NEJM 1999 CARDIOVASCULAR HEALTH STUDY
17
RELATIVE RISK OF MYOCARDIAL INFARCTIONAND STROKE / IMT ( first to fifth quintile) ___________________________________________________
IMT MI STROKE 1Q-5Q b a b a------------------------------------------------------------------------
CC 4,50 2,46 3,86 2,13------------------------------------------------------------------------
CI 4,84 3 3,66 2,35------------------------------------------------------------------------ CC+CI 6,30 3,61 4,57 2,57____________________________________________________
b= inajusted a= after adjusted for age , sex and other risk factor.
O ’LEARY et col. NEJM 1999 CARDIOVASCULAR HEALTH STUDY
18
CONCLUSIONS OF THE STUDY
INTIMA MEDIA THICKNESS OF CC AND IC STRONGLY ASSOCIATED WITH THE RISK
OF MYOCARDIAL INFARCTION AND STROKE
IN ASYMPTOMATIC
OLDER ( > 65 years) ADULTS .
19
IMT AND CORONARY
CCA AND ICA IMT ARE ASSOCIATED WITH EXISTING CORONARY HEART DISEASE
20
IMT AND THERAPEUTIC INTERVENTIONS
LIPID LOWERING TREATMENT : STATINES +++ PRIMARY PREVENTION( ACAPS /CAIUS/KAPS) SECONDARY PREVENTION ( PLAC II/MARS/REGRESS) = REGRESSION OF PROGRESSION OF IMT
BLOOD PRESSURES LOWERING DRUGS = DISCORDANCE
HORMONE REPLACEMENT THERAPY = DISCORDANCE
21
MENOPAUSE/ IMT / AND CAROTID PLAQUES
HORMONAL. NUMBER IMT c PLAQUESTREATMENT ( median value)
HRT + 39 0,729mm 15%
HR T - 55 0,782mm 51%
HRT + = with hormonal replacement therapyHRT - = without hormonal replacement therapyp< 0,005 for IMT c and < 0,0001 for plaques
M. CAZAUBON FA ALLAERT ANGEIOLOGIE 2001
22
CONCLUSIONS
ULTRASOUND IMT MEASUREMENT = METHOD NON INVASIVEREPRODUCTIBLENON EXPENSIVE
FOR DETECTION OF EARLY ATHEROSCLEROSIS
23
CONCLUSIONS
STRONG ASSOCIATION WITH VARIOUS RISK FACTORS
FOR ATHEROSCLEROSIS ( classical and emergent)
STRONG PRONOSTIC VALUE FOR CARDIOVASCULAR EVENTS = STROKE AND MYOCARDIAL INFARCTION
IMT = GOOD MARKER FOR EFFICACITY OF ANTIATHEROGENIC DRUGS
STRONG SENSIBILITY FOR STRATIFIACTION OF PETIENTS AT HIGH RISK FOR CARDIOVASCULARDISEASE