Carotid IMT and Stiffness (Imaging Campus) EE Budapest 2011_Carerj

8/3/2019 Carotid IMT and Stiffness (Imaging Campus) EE Budapest 2011_Carerj

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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

-

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

parameter)PWV

rho p rho p

. . . .

Presence of single risk factor 0.319 0.03 0.369 0.00

Mohammed M, submitted



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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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Carotid IMT and Stiffness (Imaging Campus) EE Budapest 2011_Carerj

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