carotid imt and stiffness (imaging campus) ee budapest 2011_carerj
TRANSCRIPT
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Carotid IMT and stiffness rovide additional
information to standard ultrasound
S. Carerj, MD, FESC, C.Zito MD PhDCardiology, University of Messina, Italy
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ATHEROSCLEROSIS
24%
19% 14%
12%5%
18%
13% 6%
5% 4%
000%000%
52%54%
Atherotrombosis Cancer
Infections Pulmonary disease
Coronary heart disease
Stroke
Accidents AIDS Congestive heart failure
High blood pressure
Diseases of the arteries
*Cardiovascular disease, ischemic heart disease and cerebrovascular
disease.Worldwide defined as Member States by WHO Region (African,
Americas, Eastern Mediterranean, European, South-East Asia and
Western Pacific)
Perc. breakdown of deaths from cardiovascular
diseases
Congenital cardiovascular defects
The World Health Report, 2000, WHO Geneva, 2000 AHA - Heart Disease and Stroke Statistical Update
2001
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Pyramid of atherosclerosis
AMIRest Echo WMA
Stroke
Inducibile Ischemia=WMAEchostress + CFR
Intrusive Arterial Process Stiffness
Plaque with artery flow conditioning
Endothelial dysfunction
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Early Quantitative Evaluation of
Evaluation of endothelial function (FMD)
Evaluation of Hardness of Blood Vessel Walls
presumed from the velocity of pulse waves travelling a certain
distance between the carotid artery and the femoral artery. This is
.
PressurePressure--strainstrain ElasticityElasticity ModulusModulus ((EpEp) and) and StiffnessStiffness ParameterParameter (().).
These indices directl indicate stiffness of local arterial walls.
ArterialArterial ComplianceCompliance (AC).(AC). This index indicates extensibility of a
blood vessel.
Augmentation index
Evaluation of Or anic Chan e: IMT Intima-Media Thickness
measurement is useful in the judgment of the level of atherosclerosis
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Accessible and meanin ful
Wall thickening and prevalence of atherosclerosis areassociated with coronary and cerebrovascular events
,
causing (systolic) hypertension
c c arac er s cs
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Stiffness: arteriosclerosis,
Simon A, ATVB 2010Brandts A, Radiology 2009
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What is QIMT?
Quality Intima Media Thickness (RFQIMT)
Healthy Vessel
and Adventitia (IMT)
Diameter : 5.93 mm
Diameter : 6.61 mmIMT : 976 m
30 frames/s
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Why RF signal?
There is a strong interaction between RF signal and tissueintrinsically characteristics
It contains 100% of the detected US signal information (the
following signal processing will introduce minimal
Allows Real Time analysis under a constant accurate
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Quality FEEDBACK forRFQIMT
Homogeneity of the measure profile (green)
Standard deviation
Synchronism with ECG (Vessel pulsation)
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Quality FEEDBACK forRFQIMT : NEWS
ECG s nc + Standard Deviation with value visualization
Orange > 21 < Green
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RF versus video IMT
Reproducibility 21 m ~ 50 m
Processing speed real-time off-linelabor intensive
Droste et al. Cerebrovasc Dis 2010
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ACC 34th Bethesda Conference Task Force 4:
Imaging?
Patients at intermediate risk for total VD
comprise about 40% of the adultpopulation.
and have a 6-20% 10-year risk of a hard
even s, poss y warran ng ur er
risk stratification by noninvasive tests toassess atherosclerotic burden.
son, m , umen a , ong, e es a on erence as
Force 4, J Am Coll Cardiol 2003
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Carotid IMT and Incident CV Events
1288 Finnish men; age 40-60 years, follow-up period 2 years
8 6,716,71
64,154,15
42,172,17
2 11
0 NormalNormal IMTIMT PlaquePlaque StenosisStenosis
SalonenSalonen JT et al. Arteriosclerosis and Thrombosis, 1991;11:1245JT et al. Arteriosclerosis and Thrombosis, 1991;11:1245
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Combined intimal-medial thickness
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Cavalcante JL, JACC 2011
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Insulting Leading To Structural Changes
in The Aorta and Its Functioning
Cavalcante JL, JACC 2011
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The Reflected Flows
- Pumped Blood Flow
- Reflected Blood Flow from each bifurcations
- Sum of All Reflected Blood Flows
Bifurcations Level
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Aortic Flow Vessel walls Distension Systemic Pressure
or c a ve osure
DistensionReflected waveSlow
Elastic vessel
Stiff vessel
Stroke
Volume
or c
Flow
Reflected wave
Fast
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Arterial-Ventricular Coupling: Role of
Vlacahopoulos C, Cardiology 2010
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Intrinsic and Extrinsic ParametersIntrinsic and Extrinsic Parameters
that influence Systemic Circulationthat influence Systemic Circulation
Vessel properties
and
Nathaniel Dittoe; Crit Care Med 2007
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Device and methods for determing
arterial tiffness
Laurent S. Eur Heart J 2006
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Position Statement of European Network for
S. Laurent , Eur J Cardiol 2006
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Whats RFQAS?
Quality Arterial Stiffness (RFQAS)
va ua on o e vesse wa sDistension due to Pressure Wave
mechanical push of the Pressure Wave.This wave is generated by the bloodflow through the Sistole/Diastolecardiac hases
Normal stiffnessFrame rate
.
Distension: 536 m
Stiffness PWV: 5.7 m/s
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RFQAS : What it measures?
ange o ameterDistension Stiffness
Blood Pressure Brachial AP Local AP
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RFQAS : Report
QAS WorkSheet an Report
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Aorta and Carotid
Paini A H ertension 2006
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Prediction of Cardiovascular Events
With Stiffness Parameters
Vlachopoulos C, J Am Coll Cardiol. 2010; 55: 13181327.
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A man is as old as his arteries
Thomas S denham 1624-1689
Age:24
Age:45
PWV: 5.3 m/sPWV: 8.1 m/s
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We gathered data from 16 867 subjects and patients
countries, in which PWV and basic clinical parameterswere measured. Of these, 11 092 individuals were freerom over sease, non- a e c an un rea e y
either anti-hypertensive or lipid-lowering drugs and
constituted the reference value population, of whichthe subset with optimal/normal blood pressures (BPs)(n =1455) is the normal value population.
N l l f l l it
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Normalvaluesforpulsewavevelocity:
P.Boutouyrie,
Eur
Heart
Journ
2010
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Box and whiskers Plot for IMT and -index for
,and familial hypercholesterolemics (FH)
Riggio S, Eur J Clin Invest 2010
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Box and whiskers Plot for PWV and AIx
,(PHC) and familial hypercholesterolemics
Eur J Clin Invest 2010
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STIFFNESS PARAMETERS IN PATIENTS
FACTORS AND NORMAL IMT
No. 75 subjects No. 75 subjects
p < 0.001 p < 0.01
Mohammed M, submitted
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STIFFNESS PARAMETERS IN PATIENTS
FACTORS AND NORMAL IMT
(Stiffness
parameter)PWV
rho p rho p
. . . .
Presence of single risk factor 0.319 0.03 0.369 0.00
Mohammed M, submitted
STIFFNESS PARAMETERS IN PATIENTS
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STIFFNESS PARAMETERS IN PATIENTS
FACTORS AND NORMAL IMT
Male, 41 yrs hypertensive Male, 64 yrs hypertensive and diabetic
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Linear Regression between Beta, PVW and
Anti-Scl 70 Ab
.,
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Case 1
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C 2
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Case 2
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