CAROTID INTIMA-MEDIA THICKNESS Dimitrios N. Nikas, MD, PhD, FESC Interventional Cardiologist Ioannina University Hospital
I, DIMITRIOS N. NIKAS, MD, PHD, FESC, HAVE NO CONFLICT OF INTEREST TO DECLARE RELATED TO THIS PRESENTATION
INTIMA-MEDIA THICKNESS (IMT) History What is Carotid Intima-Media Thickness (IMT) and how it should be measured? Is it important? Is it reliable? Should IMT should be measured in all Chronic Renal Failure patients?
INTIMA-MEDIA THICKNESS (IMT) THE HISTORY 1st publication on IMT
INTIMA-MEDIA THICKNESS (IMT) THE HISTORY Pingoli P et al. Circulation 1986;74:1399-1409
INTIMA-MEDIA THICKNESS (IMT) THE HISTORY Measured IMT in hyperchol patients IMT was greater in Males Smokers HyperCHOL IMT increased by age (r = 0.46, p< 0.05) Poli A, Colombo A et al. Atherosclerosis 1988;70:253-261
INTIMA-MEDIA THICKNESS (IMT) THE HISTORY IMT > 0.9 mm Leary D et al. New Eng J Med 1999; 340:14-22
INTIMA-MEDIA THICKNESS (IMT) THE HISTORY Leary D et al. New Eng J Med 1999; 340:14-22
INTIMA-MEDIA THICKNESS (IMT) THE HISTORY Leary D et al. New Eng J Med 1999; 340:14-22
INTIMA-MEDIA THICKNESS (IMT) THE ADVANTAGES Simple and bedside examination Atraumatic Easy
HOW TO DO IT... INTIMA-MEDIA THICKNESS MEASUREMENTS CONSENSUS Lorenz et al. Circulation 2007;115:459-467
HOW TO DO IT... INTIMA-MEDIA THICKNESS MEASUREMENTS CONSENSUS Lorenz et al. Circulation 2007;115:459-467
HOW TO DO IT... INTIMA-MEDIA THICKNESS MEASUREMENTS CONSENSUS 1. Which part of CCA/ICA should be used for IMT measuring? 2. Where exactly to measure? 3. Should we use the max or the mean values? 4. Should we use only one carotid or both?
HOW TO DO IT... INTIMA-MEDIA THICKNESS MEASUREMENTS CONSENSUS - APPROPRIATE EQUIPMENT 1. Modern high-resolution equipment 2. U/S transducer > 7.0 MHz 3. Image acquisition > 25 Hz 4. Log gain approx. 60 db Touboul PJ et al. Cerebrovasc Dis 2012;34:290-296
HOW TO DO IT... INTIMA-MEDIA THICKNESS MEASUREMENTS CONSENSUS - EXAMINATION PROTOCOL 1. Both arterial segments should appear in longitudinal way 2. Far-wall of CCA 5mm proximal the bifurcation 3. In a 10mm area 3.1. 3.2. free of plaques clearly defined by double line pattern 4. Both side carotids should be evaluated Touboul PJ et al. Cerebrovasc Dis 2012;34:290-296
HOW TO DO IT... INTIMA-MEDIA THICKNESS MEASUREMENTS CONSENSUS - EXAMINATION PROTOCOL Touboul PJ et al. Cerebrovasc Dis 2012;34:290-296
HOW TO DO IT... INTIMA-MEDIA THICKNESS MEASUREMENTS CONSENSUS - EXAMINATION PROTOCOL 1. 2. 1. Manual measurements require meticulous control Automated systems are better 1. 2. provide multiple measurements Calculate with great accuracy the max/mean value of IMT in every-single point in a 10mm long segment in CCA Measurements should be obtained in the end-diastole point Touboul PJ et al. Cerebrovasc Dis 2012;34:290-296
WHAT WE KNOW INTIMA-MEDIA THICKNESS (IMT) 1. 2. 3. 4. 5. Correlate well with patient s history Associate with classical risk factors associate with the presence of advanced atherosclerotic disease, including coronary artery disease It can predict future cardiovascular events The higher the IMT the greater the risk
WHAT WE KNOW INTIMA-MEDIA THICKNESS (IMT) Lorenz et al. Circulation 2007;115:459-467
WHAT WE KNOW INTIMA-MEDIA THICKNESS (IMT) - IN RENAL FAILURE PATIENTS 138 hemo-dialysis and peritoneal-dialysis patients were evaluated for IMT Followed-up for 29.8 ± 15.0 months I tertile: IMT < 0.95mm II tertile: IMT 0.95mm - 1.10mm III tertile: IMT >1.10 Benedetto et al. J Am Soc Nephrol 2001;12:2458-2464
WHAT WE KNOW INTIMA-MEDIA THICKNESS (IMT) - IN RENAL FAILURE PATIENTS 438 hemo-dialysis patients were evaluated for IMT Followed-up for 30 months 16,0 Cardiovascular Mortality accorting to IMT odds ratio odds ratio 12,0 8,0 4,0 0,0 < 1.0 mm 1.0-2.0 mm > 2.0 mm IMT thickness < 1.0 > 0,0 4,0 8,0 12,0 16,0 1.0 2.0-2.0 mm mm Nishizawa et al. Am J Kidney Dis 2003;41:S76-9
WHAT WE KNOW INTIMA-MEDIA THICKNESS (IMT) - IN RENAL FAILURE PATIENTS 78 CRF patients were evaluated for IMT along with other traditional risk factors Dialysis patients were compared to those without Paul J et al. North Am J Med Sci 2012;4:77-80
CONCLUSIONS INTIMA-MEDIA THICKNESS (IMT) AND IN RENAL FAILURE PATIENTS Simple and easy test to estimate presence of advanced cardiovascular disease to predict future cardiovascular events to evaluate prognosis regarding MI and stroke in ESRF patients
INTIMA-MEDIA THICKNESS (IMT) THE HISTORY