Use Of Carotid Intima-media Thickness Research Articles

Psoriasis and Cardiovascular Risk in Children: The Usefulness of Carotid Intima-Media Thickness.

Psoriasis is a skin disorder which mostly affects adults, beginning in childhood in almost one-third of patients. In adults it is associated with increased risk for cardiovascular diseases (CVD), while this association is still debated at younger age. Our aim was to evaluate the association between psoriasis and metabolic markers and cardiovascular findings in this age group. Twenty consecutive patients previously diagnosed with psoriasis (group A) were enrolled and compared with healthy non- psoriatic age- and sex-matched subjects (group B). The severity of the disease, CV risk factors, including anthropometric data with adiposity and its distribution, blood pressure (BP), laboratory metabolic tests, echocardiography and vascular ultrasound (transcranial echo-Doppler and carotid artery echo-Doppler with carotid intima-media thickness, cIMT) were performed for each subject. Personal history for CV risk, BP, anthropometric data were similar between the two groups, while familiar history for psoriasis was more frequent in group A (p < 0.02). C-IMT was significantly higher in group A compared to B (right, p = 0.001; left, p = 0.002). In addition, c-IMT was positively correlated with disease duration, triglycerides and triglycerides/glucose. Cerebral flow velocities, cardiac measurements, systo-diastolic function, ventricle geometry and mass were normal and comparable between the two groups, and did not correlate with CV risk factors. In childhood psoriasis c-IMT could represent a marker of pre-clinical cardiovascular involvement and contribute to start a personalized management, while cardiac findings seem to be normal in the early stage of disease. Longitudinal studies can clarify the progression of CV involvement in paediatric-onset psoriasis.

Prediction of carotid intima-media thickness and its relation to cardiovascular events in persons with type 2 diabetes

AimsTo investigate measures of carotid intima-media thickness (IMT) and conventional cardiovascular (CV) risk factors as predictors of future carotid IMT, and the prediction of CV events during follow-up based on measures of carotid IMT. MethodsObservational longitudinal study including 230 persons with type 2 diabetes (T2D). ResultsMean age at follow-up was 66.7 (SD 8.5) years, 30.5% were women and mean body mass index (BMI) was 31.8 (4.4) kg/m2. Carotid IMT was measured at baseline, after 18 months of intervention in the Copenhagen Insulin and Metformin Therapy (CIMT) trial and after a mean follow-up of 6.4 (1.0) years. Baseline carotid IMT, carotid IMT after 18 months' intervention, and CV risk factors (age, sex and baseline systolic blood pressure) gave the best prediction of carotid IMT (root mean-squared error of prediction of 0.106 and 95% prediction error probability interval of −0.160, 0.204). ConclusionsMeasures of carotid IMT combined with CV risk factors at baseline predicts attained carotid IMT better than measures of carotid IMT or CV risk factors alone. Carotid IMT did not predict CV events, and the present results do not support the use of carotid IMT as a predictor of CV events in persons with T2D.

Carotid artery stenosis screening: where are we now?

Stroke poses a significant burden on healthcare and is the second largest cause of death globally. Both medical and surgical interventions to reduce the risk of stroke in asymptomatic patients have been shown to be effective but identifying the target at risk population is more problematic. Screening for carotid artery stenosis offers one pathway for this, as there is some correlation between risk of stroke and extent of stenosis. Identification of patients who are at risk of cardiovascular disease as well as stroke, allows initiation of effective medical treatment of modifiable risk factors to address this risk. In addition, carotid intima-media thickness is a way of assessing systemic atherosclerosis and may be valuable in risk stratification of patients for cardiovascular disease. Given the low prevalence of stenosis in the general population and the risks associated with undergoing surgical intervention, population wide screening is not recommended. This recommendation has not changed over the last 15 years, since the last major studies evaluating management and outcomes were published. However, both medical and surgical/endovascular treatments have advanced over that time. Further studies are underway to compare current treatments for the appropriate management of both symptomatic and asymptomatic patients with stenosis. Two of these trials, ECST-2 and CREST-2, are expected to be completed in the next 2-4 years and the results may initiate changes in the recommendations. The use of carotid intima-media thickness alongside traditional risk scores is controversial and more research is required in this area.

Effects of Exercise on Carotid Arterial Wall Thickness in Obese Pediatric Populations: A Meta-Analysis of Randomized Controlled Trials.

In pediatric populations, the use of carotid intima-media thickness (IMT) as a marker of cardiovascular risk has increased. However, previous studies examining the effects of exercise training on arterial structure and function in obese children and adolescents have shown inconsistent findings. The primary aim of this systematic review and meta-analysis is to expand on the current body of literature by providing a quantitative estimate of the change in carotid IMT following exercise training as well as to provide an exploratory analysis of potential moderators associated with the variation in response to an exercise training intervention in overweight and obese youth. A computerized search was made using three databases. The analysis was restricted to studies that examined the effect of exercise interventions on carotid IMT in pediatric obesity (6-18-year-olds). Hedges' g and 95% confidence intervals (CIs) were calculated. Six randomized controlled trials (303 youths) were included. Exercise was associated with a small-to-moderate but significant reduction in carotid IMT (g = -0.306; 95% CI -0.540 to -0.072; p = 0.011). Likewise, exercise program duration per week significantly influenced the effect of exercise on carotid IMT (β = -0.060; p = 0.015). Exercise seems to reduce carotid IMT in childhood obesity. Therefore, encouraging obese pediatric individuals to become physically active can lead to favorable changes in the arterial wall.

The year in cardiology 2016: peripheral circulation.

In an epidemiological update in 2016, cardiovascular (CV) disease has been estimated as cause of 45% of deaths in Europe, including 12% due to stroke and 14% to other CV diseases, highlighting the major burden of non-coronary artery diseases (i.e. aorta, carotid, and lower extremity arteries) and venous thromboembolism (VTE) in our continent ( Figure 1 ).1 Similar to previous years,2,3 relevant scientific evidence in these fields was brought out in 2016 which will affect our daily clinical practice. Figure 1 Proportion of all deaths due to major causes in Europe, latest available year (adapted from Townsend).1 In the new ‘2016 European guidelines on cardiovascular disease prevention in clinical practice’, the usefulness of carotid intima-media thickness to stratify CV risk has been strikingly challenged, and this marker is no longer recommended due to its high variability, low intra-individual reproducibility, and lack of added predictive value, even in intermediate risk subjects.4 In opposition, carotid plaque remains a valuable tool for CV risk stratification. In 2016, the long-term clinical equipoise of carotid artery stenting (CAS) vs. carotid endarterectomy (CEA) was confirmed by the 10 year analysis of the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST), reporting similar rates of death, stroke, or MI within 30 days, or ipsilateral stroke up to 10 years for both strategies (11.8% vs. 9.9%; P = 0.51) ( Table 1 ).5 View this table: Table 1 Summary of major randomized trials in the aorta, peripheral artery diseases, and venous thrombo-embolic disease in 2016 Peri-procedural stroke during CAS is often related to plaque embolization. The randomized Asymptomatic Carotid Trial (ACT) I compared CAS with embolic protection to CEA in 1453 patients with asymptomatic carotid stenosis, not considered at high surgical risk ( Table 1 ).6 The composite endpoint of death, stroke, or MI at 30 days, or ipsilateral stroke at 1 year, was non-inferior in CAS …

Carotid Ultrasound Maximum Plaque Height-A Sensitive Imaging Biomarker for the Assessment of Significant Coronary Artery Disease.

We investigated the use of carotid intima-media thickness and carotid plaque in predicting significant angiographic coronary stenosis. Three hundred eighteen consecutive outpatients underwent angiography and carotid ultrasound on the same day. The extent of coronary stenosis was determined using an established scoring system. Mean far distal carotid intima-media thickness of the common carotid artery, maximum plaque height, and total plaque area in the bulbs were measured by ultrasound. Cutoff values were identified using a receiver operating characteristic curve for predicting and ruling out coronary artery disease. The mean ± SD carotid intima-media thickness (≥50% stenosis = 0.91 ± 0.23 mm, <50% stenosis = 0.82 ± 0.18 mm), maximum plaque height (≥50% stenosis = 2.64 ± 0.85 mm, <50% stenosis = 1.72 ± 1.04 mm), and total plaque area (≥50% stenosis = 39.1 ± 27.7 mm(2) , <50% stenosis = 22.2 ± 23.4 mm(2) ) were significantly higher in patients with coronary artery disease (P ≤ 0.001 for all three comparisons). Increased CIMT, plaque height, and area correlated with increased number of affected vessels. Plaque height had the best negative likelihood ratio for ruling out disease (0.15). The optimal threshold values for predicting coronary disease were 0.82 mm for carotid intima-media thickness, 1.54 mm for plaque height, and 25.6 mm(2) for total plaque area. Increased carotid intima-media thickness and plaque measurements are indicative of the presence of epicardial coronary stenosis. Plaque burden is a more sensitive imaging biomarker for ruling out significant coronary artery disease, including in younger individuals.

Assessment of subclinical atherosclerosis by carotid intima media thickness: technical issues

Carotid intima-media thickness assessed by ultrasonography of carotid arteries is a safe, non-expensive, feasible and accurate method for detecting early signs of atherosclerosis and carotid intima-media thickness and change in carotid intima-media thickness over time reflect cardiovascular disease risk. Technical aspects impact on the measurement, variability and interpretation of carotid intima-media thickness. These include device aspects, inter- and intra-sonographer variability and the ultrasound protocol used. The mean common carotid intima-media thickness and the mean maximum common carotid intima-media thickness are the most widely used carotid intima-media thickness measurements. Common carotid intima-media thickness values of around 0.5 mm are considered 'normal' in young adults. Values are higher in men than in women, in African-Americans than Caucasians and increase with age. Carotid intima-media thickness values at or above the 75th percentile of a reference population indicate increased cardiovascular risk. Guidelines differ in their recommendations for the use of carotid intima-media thickness measurements for risk assessment in primary prevention because evidence suggesting that it improves upon conventional risk scores is inconsistent. Carotid intima-media thickness is frequently used in clinical trials as a surrogate endpoint for cardiovascular events on the assumption that regression or slowed progression of carotid intima-media thickness, induced by cardiovascular risk interventions, reflects a reduction in cardiovascular events. However, further data are required to confirm this linear relationship. No international guidelines exist on the use of carotid intima-media thickness as a research tool. Quality control in acquisition, measurement and interpretation of carotid intima-media thickness are important considerations and the carotid intima-media thickness protocol used should be determined by the research question under investigation.

Tu1515 Endoscopic Ultrasound (EUS) for Measurement of Aortic Intima-Media Thickness: A Marker for Presence of Coronary Artery Disease

Tu1515 Endoscopic Ultrasound (EUS) for Measurement of Aortic IntimaMedia Thickness: A Marker for Presence of Coronary Artery Disease Seyed Amir Mirbagheri*, Mohammad R. Ostovaneh, Elham Mortazavi Department of Internal Medicine, Gastroenterology, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran Background: Previous studies highlighted the superior independent and incremental value of measures of vascular function like aortic distensibility for predicting atherosclerosis and identification of high risk individuals. Despite the controversies, some consensus statements suggest the use of carotid intimamedia thickness for further clarification of coronary artery disease (CAD) risk assessment. There are studies that evaluated the relationship between Aortic intima-media thickness measured by transesophageal echocardiography and CAD. Endoscopic Ultra-Sound (EUS) technique can serve as a highly accurate technique for measuring the Aortic Intima-Media Thickness (AIMT). To our best knowledge, there is no study to measure the AIMT with EUS and evaluate its relationship with CAD .Aim: to evaluate the relationship between EUS-measured AIMT and presence of coronary artery disease in patients who underwent coronary angiography (CAG). Methods: Two hundred and fifty eight patients who previously underwent CAG and needed to perform EUS for a gastrointestinal reason involved in the study. After obtaining demographic data, AIMT was measured at the aortic arch level with a radial EUS (frequency 10 MHz) for all patients. The endosonologist was blind in regard of CAG result. The patients were then subgrouped into normal individuals without CAD and those with CAD, based on cardiologist-reported CAG and the AIMT was compared between two groups. Results: In patients with normal CAG, the AIMT was 1.49 0.53 mm (CI 0.84-1.14), while it was 1.89 0.53 (CI 1.23-2.55) in presence of CAD(p 0.001). The AIMT increased with age (correlation coefficient 0.557, P 0.001). When compared to normal 20 to 30 years old individuals without CAD risk factors, patients with CAD in CAG had significantly higher AIMT (1.89 0.53 compared to 1.47 .47, P 0.01). On the other hand, AIMT did not differ in normal 20 to 30 years old patients without CAD risk factors compared to the remaining individuals with normal CAG (1.47 0.53 vs 1.63 0.55, P 0.151). When adjusting for age and presence of diabetes mellitus and hyperlipidemia in a logistic regression model, the regression coefficient for AIMT for predicting the presence of CAD in CAG as outcome variable was 0.581 (P 0.001) and subsequently odds ratio was 1.79. Conclusion: AIMT is significantly different in presence or absence of CAD. Even though, it increases with age but adjustment for age revealed its pure effect to predict presence of CAD. AIMT could be used as an independent predictor for presence of CAD. EUS is one of the most accurate techniques to measure AIMT. Evaluation of AIMT in patients who are candidates for EUS for any reason may be useful for detecting the subclinical CAD and optimizing patient management.

Carotid intima-media thickness in individuals with and without type 2 diabetes: a reproducibility study

BackgroundThe use of carotid intima-media thickness (carotid IMT) as a surrogate marker of cardiovascular disease is increasing and the method has now also been applied in several trials investigating patients with type 2 diabetes (T2D). Even though knowledge about methodology is of highest importance in order to make accurate power calculations and analyses of results, no reproducibility studies have been performed in this group of patients. The aim of this study was to quantify the variability of the measurement of carotid IMT in individuals with and without T2D.MethodsWe used B-mode ultrasound and a computerized software programme (MIA vascular tools) for analysis of carotid IMT. Measurement of carotid IMT in the far wall of the common carotid artery (CCA) was done for 30 patients with T2D and 30 persons without T2D. The examinations were done by two different sonographers and two different readers on two separate days in order to quantify sonographer-, reader-, and day-to-day variability.ResultsComparisons of measurement of carotid IMT in CCA between sonographers (sonographer variability) resulted in limits of agreement (LoA) from -0.18 to 0.13 mm for patients with T2D and -0.12 to 0.10 mm for persons without T2D. This means, that a second scanning of the same person with 95% probability would be within this interval of the first scanning. Comparisons between readers assessing the same scanning (reader variability) resulted in LoA from -0.05 to 0.07 mm and -0.04 to 0.05 mm respectively. LoA of the day-to-day variability was -0.13 to 0.18 mm and -0.09 to 0.18 mm respectively. This corresponds to coefficients of variations (CV) of the sonographer- and day-to-day variability of 10% in patients with T2D and 8% in persons without T2D. The CV of the reader variability was 4% and 3% respectively.ConclusionMeasurement of carotid IMT in the CCA can be determined with good and comparable reproducibility in both patients with T2D and persons without T2D. These findings support the use of carotid IMT in clinical trials with T2D patients and suggest that the numbers of patients needed to detect a given difference will be the same whether the patients have T2D or not.

Relationship between carotid intima-media thickness and coronary angiographic findings: a prospective study

BackgroundSince cardiovascular diseases are associated with high mortality and generally undiagnosed before the onset of clinical findings, there is a need for a reliable tool for early diagnosis. Carotid intima-media thickness (CIMT) is a non-invasive marker of coronary artery disease (CAD) and is widely used in practice as an inexpensive, reliable, and reproducible method. In the current study, we aimed to investigate prospectively the relationship of CIMT with the presence and extent of significant coronary artery narrowing in patients evaluated by coronary angiography for stable angina pectoris.MethodsOne hundred consecutive patients with stable angina pectoris and documented ischemia on a stress test were included in the study. The patients were divided into two groups according to the result of the coronary angiography: group 1 (39 patients) without a noncritical coronary lesion, and group 2 (61 patients) having at least one lesion more than 50% within the main branches of the coronary arteries. All of the patients underwent carotid Doppler ultrasound examination for measurement of the CIMT by a radiologist blinded to the angiographic data.ResultsThe mean CIMT was 0.78 ± 0.21 mm in Group 1, while it was 1.48 ± 0.28 mm in Group 2 (p = 0.001). The mean CIMT in patients with single vessel disease, multi-vessel disease, and left main coronary artery disease were significantly higher compared to Group 1 (1.2 ± 0.34 mm, p = 0.02; 1.6 ± 0.32 mm, p = 0.001; and 1.8 ± 0.31 mm, p = 0.0001, respectively). Logistic regression analysis identified CIMT (OR 4.3, p < 0.001) and hypertension (OR 2.4, p = 0.04) as the most important factors for predicting CAD.ConclusionsThe findings of this study show that increase in CIMT is associated with the presence and extent of CAD. In conclusion, we demonstrated the usefulness of carotid intima-media thickness in predicting coronary artery disease but large-scale studies are required to define its role in clinical practice.

Usefulness of Carotid Intima-Media Thickness in Patients With Diabetes Mellitus as a Predictor of Coronary Artery Disease

Identification of asymptomatic patients with diabetes mellitus (DM) at increased risk for coronary artery disease (CAD) remains a challenge. Carotid intima-media thickness (CIMT) has been proposed as a surrogate marker for CAD but only limited data are available. The purpose of the study was to evaluate the potential of CIMT for prediction of CAD in asymptomatic patients with DM. Prospectively, CIMT of the left and right common carotid arteries was assessed by B-mode ultrasound in 150 asymptomatic diabetic patients (50 +/- 13 years old, 83 men). In addition, noninvasive multislice computed tomographic coronary angiography was performed to relate CIMT to the presence and severity of CAD. For this purpose, patients were classified as having (1) no atherosclerosis, (2) nonobstructive atherosclerosis, or (3) obstructive stenosis with >or=50% luminal diameter narrowing. Mean CIMT increased significantly from 0.58 +/- 0.08 mm in patients with normal coronary arteries (n = 59, 39%) to 0.67 +/- 0.12 mm in patients with nonobstructive atherosclerosis (n = 54, 36%). Highest mean CIMT (0.75 +/- 0.12 mm) was observed in patients with obstructive stenosis (n = 36, 25%, p <0.01). Receiver operating characteristics curve analysis yielded a sensitivity and specificity of 85% and 72%, respectively, with a CIMT cut-off value of 0.67 mm, for predicting obstructive coronary atherosclerosis. Multivariate analysis of baseline risk factors showed CIMT to be an independent predictor of any and obstructive atherosclerosis (p <0.01). In conclusion, a significant relation was shown between CIMT and the presence and severity of CAD in asymptomatic patients with DM. Assessment of CIMT may be useful to identify diabetic patients at higher risk for CAD.

Use of Carotid Intima-Media Thickness to Identify Patients With Ischemic Stroke and Transient Ischemic Attack With Low Yield of Cardiovascular Sources of Embolus on Transesophageal Echocardiography

Carotid intima-media thickness (CIMT) is associated with systemic atherosclerosis and cardioembolic conditions and predicts the risk of recurrent strokes. We sought to establish the relationship between CIMT and cardiovascular sources of embolus (CSE) on transesophageal echocardiography (TEE) and hypothesized that a noninvasive strategy of CIMT assessment and transthoracic echocardiography bubble study would identify patients with ischemic stroke or transient ischemic attack in whom TEE would provide little incremental diagnostic yield. In 180 patients with ischemic stroke or transient ischemic attack of undetermined origin referred for TEE, we prospectively performed CIMT measurement/plaque screen (Phase 1, n=96) or CIMT measurement/plaque screen and transthoracic echocardiography bubble study (Phase 2, n=84) before TEE. Phase 1 results were used to construct receiver operating characteristic curves to demonstrate the ability of CIMT to detect CSE on TEE and to identify the optimal CIMT cutoff value for prospective strategy testing (Phase 2). In Phase 1, CIMT was found to correlate with TEE markers of aortic atherosclerosis, including complex aortic plaques, and combined CSE. The optimal CIMT cutoff for detection of CSE on TEE was 0.78 mm. In Phase 2, a positive noninvasive strategy test (CIMT >or=0.78 mm, +carotid plaque, and/or a positive transthoracic echocardiography bubble study) was present in 61%. The prevalence of CSE on TEE was significantly higher among those with a positive compared with a negative noninvasive strategy test (65% versus 9%, P<0.001), and this strategy had a sensitivity of 92% and a negative predictive value of 91% for the detection of any CSE on TEE. In patients with stroke or transient ischemic attack of undetermined origin, a noninvasive strategy of CIMT assessment/plaque screen and transthoracic echocardiography bubble study can identify patients in whom further invasive evaluation with TEE will be of low diagnostic yield.

Recent Advances of Intervention to Inhibit Progression of Carotid Intima-Media Thickness in Patients With Type 2 Diabetes Mellitus

Type 2 diabetes is associated with a high cardiovascular morbidity and mortality. Recent advances of intervention studies in type 2 diabetes with use of carotid intima-media thickness (CIMT) measurement as a surrogate end point may allow for better understanding of the undetermined process of atherosclerosis, the effect of interventions, and the usefulness of CIMT to inhibit events of cardiovascular disease. Data were available from 11 studies (n=1578) in subjects with type 2 diabetes (including impaired glucose tolerance, n=132) that evaluated the effect of interventions on change in CIMT. The overall weighed rate of change in mean CIMT based on data among control groups (ie, type 2 diabetes without interventions) was 0.034 mm/y (95% CI, 0.029 to 0.039; median SD, 0.054), in which mean HbA(1c) was 7.86% (95% CI, 7.72 to 8.00; median SD, 1.5). A significant close correlation of HbA(1c) with rate of CIMT change was found (R(2)=0.35, P=0.01). Agents for lowering of blood glucose, platelet activation, or blood pressure significantly reduced the CIMT increase, independent of blood glucose control. This implies that other mechanisms of such agents to diminish CIMT increase should be explored. CIMT measurement may contribute to elucidating the short- and/or long-term effect of interventions on the rate of change in CIMT in relation to the levels of various risk factors. Although the method needs further standardization, pharmacological interventions are likely to inhibit progression of CIMT, leading to a reduction of cardiovascular events.

IMT for the Elderly?

To the Editor: I would like to respond to an article published in a recent issue of Stroke , entitled “Is Carotid Intima-Media Thickness Useful in Cardiovascular Disease Risk Assessment?”1 The title of the article caught my eye because my profession involves extensive use of carotid intima-media thickness (CIMT) for detection of atherosclerosis. However, I was surprised that the title did not reflect the misleading nature of the article, and it appears to refute the authors’ earlier published works.2 The title of the article suggests that certain cardiovascular risks were compared with assessment of CIMT. The authors of this article concluded that as a screening tool, CIMT does not represent a substantial increase in the predictive value for cardiovascular events. Moreover, there was an inference that CIMT cannot be used alone as a screening tool. I must completely disagree. The article described the Rotterdam Study, in which investigators used CIMT as a screening tool in an elderly population. This was a select population that would have additional risk factors present. The question should have been raised as to whether exclusive use of CIMT in a younger population with risk factors is able to identify the presence of cardiovascular disease in its earliest …