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INTIMA MEDIA THICKNESS AND ATHEROSCLEROSIS

Michele CAZAUBON, MD, PhD

American Hospital of Paris ( France)

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INTIMA MEDIA THICKNESS AND ATHEROSCLEROSIS

ATHEROSCLEROSIS = ARTERIAL WALL DISEASE

CLINICAL MANIFESTATIONS WHEN ADVANCED

IMPORTANCE OF SCREENING FOR PRECLINICALSTAGE

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DOPPLER ULTRASOUND IMAGINGDOPPLER ULTRASOUND IMAGING AND ARTERIAL WALLAND ARTERIAL WALL

PLAQUE•GRADE %•ECHOGENICITY

INTIMA-MEDIATHICKNESS (IMT)

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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)

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IMT & ATHEROSCLEROSIS

E= IMT D = DIAMETER Nb = NB OF Points 212/1cm

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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 )

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•FEASABILITY OF MEASURE

•1/ CAROTID ARTERY•DISTAL COMMON CAROTID = 99% > BIFURCATION AND INTERNAL CAROTID

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IMT AND « CLASSICAL »RISK FACTORS

AGEGENDER SMOKING

HIGH BLOOD PRESSURECHLOL AND DIABETE

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NEW RISK FACTORS /1

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1/HYPERHOMOCYSTEINEMIA

ASAP ( Antioxidant Supplementation in

Atherosclerosis Prevention study )-EIM dans groupe avec HC

(SALONEN ANN MED INT 1998)

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NEW RISK FACTORS /2

2/ STANDING AT WORK PROGRESSION = 0,08 to 0,67mmbetween men standing at work NEVER / ALWAYS.

(SALONEN Environ Health 2000)

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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)

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IMT = SENSITIVE INDICATOR FOR THE PRESENCE OF PLAQUEIN THE BIFURCATION OF COMMON CAROTID

EVA ’ STUDY ( Broussais .1996. 100 sujets 4 years follow up)

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IMT c AND CAROTID STENOSIS

CORRELATIONBETWEEN IMT c AND

SEVERITY ATHEROSCLERIS

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ASSOCIATION BETWEEN IMT AND PREVALENCEOF PLAQUES

BASELINE IMT - CCA IS AN INDEPENDANT PREDICTOR OF CAROTID PLAQUE OCCURRENCE

INCREASED WALL THICKNESS PRECEDE PLAQUE FORMATION

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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 )

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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

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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

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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 .

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IMT AND CORONARY

CCA AND ICA IMT ARE ASSOCIATED WITH EXISTING CORONARY HEART DISEASE

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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

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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

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CONCLUSIONS

ULTRASOUND IMT MEASUREMENT = METHOD NON INVASIVEREPRODUCTIBLENON EXPENSIVE

FOR DETECTION OF EARLY ATHEROSCLEROSIS

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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