INTIMA MEDIA THICKNESS AND ATHEROSCLEROSIS

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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
PRECLINICAL STAGE
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DOPPLER ULTRASOUND IMAGING
AND ARTERIAL WALL

• PLAQUE
• GRADE
• ECHOGENICITY

INTIMA-MEDIA THICKNESS (IMT)
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ANATOMICAL AND HISTOLOGY STUDY NORMAL ARTERIAL
WALL IN B.MODE ULTRASOUND

• ?
• 1st ECHOGENIC LINEA
• LUMEN/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 gt 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 gt BIFURCATION
  AND INTERNAL CAROTID

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IMT AND  CLASSICAL  RISK FACTORS
AGE GENDER SMOKING HIGH BLOOD PRESSURE CHLOL ?
AND DIABETE
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NEW RISK FACTORS /1 1
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
0,67mm between 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 PLAQUE IN THE BIFURCATION OF
COMMON CAROTID EVA  STUDY ( Broussais .1996.
100 sujets 4 years follow up)
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IMT c AND CAROTID STENOSIS
CORRELATION BETWEEN IMT c AND SEVERITY
ATHEROSCLERIS
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? ASSOCIATION BETWEEN IMT ? AND ? PREVALENCE OF
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 gt 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 INFARCTION AND 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 3,6
6 2,35 -------------------------------------------
-----------------------------
CCCI 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 ( gt 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
PLAQUES TREATMENT ( median value) HRT
39 0,729mm 15 HR T -
55 0,782mm 51 HRT with
hormonal replacement therapy HRT - without
hormonal replacement therapy plt 0,005 for IMT c
and lt 0,0001 for plaques M. CAZAUBON FA
ALLAERT ANGEIOLOGIE 2001

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CONCLUSIONS
ULTRASOUND IMT MEASUREMENT METHOD NON
INVASIVE REPRODUCTIBLE NON 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 CARDIOVASCULAR DISEASE