2e DOPPLER DONG MACH NAO NGOAI SO 12 2014

"People only see what they are prepared to see." Ralph Waldo Emerson CIMT (Carotid Intima-Media Thickness) WHY? WHEN? HOW TO MEASURE? Dr NGUYỄN QUANG TRỌNG website: cdhanqk.com (Last update, 10/12/2014) IMAGING DEPARTMENT FV HOSPITAL – HCM CITY 10 December 2014 CONTENT          Tổng quan CIMT – Why? History CIMT vs Plaque CIMT – When? CIMT – How to measure? Technique Conclusion References TỔNG QUAN   Để giảm thiểu tử vong bệnh lý tim mạch, người ta quan tâm nhiều đến việc điều trị dự phịng nhóm bệnh nhân không triệu chứng nguy cao Được nhắc đến nhiều Nghiên cứu Framingham (Framingham Heart Study): Ước lượng nguy bệnh lý tim mạch 10 năm người 55 tuổi theo yếu tố nguy cơ:  Tuổi  Giới tính  Huyết áp  Cholesterol toàn phần  HDL Cholesterol  Tiểu đường  Hút thuốc Circulation 1998;97:1837-1847 Screening for asymptomatic atherosclerosis is needed to prevent symptomatic (fatal and or costly) ACVD Morteza Naghavi, MD Asymptomatic Atherosclerosis Pathophysiology, Detection and Treatment Springer Science+Business Media, LLC 2010 Morteza Naghavi, MD Asymptomatic Atherosclerosis Pathophysiology, Detection and Treatment Springer Science+Business Media, LLC 2010 Kết hợp cholesterol huyết áp tâm thu lên bệnh mạch vành nghiên cứu Framingham Dữ liệu BN nam, 44–62 tuổi (CHD indicates coronary heart disease; Sys, systolic blood pressure) Morteza Naghavi, MD Asymptomatic Atherosclerosis Pathophysiology, Detection and Treatment Springer Science+Business Media, LLC 2010 Estimated 10-Year Rate (%) Ước lượng nguy bệnh lý tim mạch 10 năm người 55 tuổi theo yếu tố nguy cơ: Framingham Heart Study 40 35 30 25 20 15 10 37 27 25 20 Men Women 13 A B C A D B C D Blood Pressure (mm Hg) 120/80 140/90 140/90 140/90 Total Cholesterol (mg/dL) 200 240 240 240 HDL Cholesterol (mg/dL) 50 50 40 40 Diabetes No No Yes Yes Cigarettes No No No Yes mm Hg = millimeters of mercury mg/dL = milligrams per deciliter of blood Circulation 1998;97:1837-1847 National Cholesterol Education Program - U.S DEPARTMENT OF HEALTH AND HUMAN SERVICES May 2001 National Cholesterol Education Program - U.S DEPARTMENT OF HEALTH AND HUMAN SERVICES May 2001 Samia Mora et al Interaction of Body Mass Index and Framingham Risk Score in Predicting Incident Coronary Disease in Families Circulation 2005; 111: 1871-1876 CIMT < 75th percentile CIMT < 75th percentile RCIMT > 75th percentile CIMT < 75th percentile CIMT > 75th percentile CONCLUSION       CIMT đo giới hạn thành xa động mạch cảnh chung hai bên Ngoài ra, cần phải khảo sát động mạch cảnh sọ (CCA, ICA) để tìm mảng vữa xơ nhằm giúp tăng độ nhạy tiên lượng nguy bệnh lý timmạch CIMT mảng vữa xơ (plaque) hai yếu tố tiên lượng khác (different phenotypes) cho nguy bệnh lý tim-mạch Mảng vữa xơ diện tiềm ẩn nhiều nguy bệnh lý tim mạch CIMT Tuy nhiên, CIMT tăng bề dày bất thường vừa yếu tố tiên lượng nguy bệnh lý tim-mạch vừa giúp tiên đốn hình thành mảng vữa xơ sau Sự thay đổi thành mạch phản ánh qua việc đo đạc CIMT, khác với tổn thương khu trú mảng vữa xơ Vì thế, cần phải phân biệt rõ CMIT mảng vữa xơ quy trình khảo sát báo cáo kết Sự diện mảng vữa xơ CIMT ≥ 75th percentile (bách phân vị) theo tuổi, giới tính chủng tộc yếu tố tiên lượng nguy gia tăng bệnh lý tim-mạch Plaque and CHD Incidence: ARIC Study (Nambi et al., JACC 2010) * No history of angina, heart attack, stroke, or peripheral arterial disease †Must not have any of the following: total cholesterol level >200 mg/dL (5.18 mmol/L), blood pressure >120/80 mm Hg, diabetes mellitus, smoking, family history of coronary heart disease, or the metabolic syndrome ‡Population aged >75 years is considered high risk and must receive therapy without testing for atherosclerosis **High cholesterol, high blood pressure, diabetes, smoking, family history of coronary heart disease, or the metabolic syndrome Atherosclerosis test flow chart of the first SHAPE (Screening for Heart Attack Prevention and Education) guideline from 2006 ABI—ankle- brachial index; CACS—coronary artery calcium score; CIMT—carotid intima–media thickness; CRP—C-reactive protein; LDL—lowdensity lipoprotein Erling Falk & Prediman K Shah The SHAPE Guideline: Ahead of Its Time or Just in Time? Curr Atheroscler Rep DOI 10.1007/s11883-011-0195-y Springer Science+Business Media, LLC 2011 REFERENCES                PAOLO PIGNOLI et al Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging Circulation 74 no 6, 1399-1406, 1986 James H Stein et al ASE CONSENSUS STATEMENT Use of Carotid Ultrasound to Identify Subclinical Vascular Disease and Evaluate Cardiovascular Disease Risk: A Consensus Statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force Journal of the American Society of Echocardiography February 2008 P.-J Touboul et al Mannheim Carotid Intima-Media Thickness Consensus (2004 - 2006 - 2011) An Update on Behalf of the Advisory Board of the 3rd and 4th Watching the Risk Symposium 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006 and Hamburg, Germany, 2011 Morteza Naghavi, MD Asymptomatic Atherosclerosis Pathophysiology, Detection and Treatment Springer Science+Business Media, LLC 2010 National Cholesterol Education Program - U.S DEPARTMENT OF HEALTH AND HUMAN SERVICES May 2001 Samia Mora et al Interaction of Body Mass Index and Framingham Risk Score in Predicting Incident Coronary Disease in Families Circulation 2005; 111: 1871-1876 Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M Prediction of clinical cardiovascular events with carotid intimamedia thickness A systematic review and meta-analysis Circulation 2007;115:459–67 Journal of the American Society of Echocardiography 2008 21, 112-116DOI: (10.1016/j.echo.2007.05.002) The number of publications using ―carotid intima-media thickness‖ in the title or abstract as assessed using PubMed database (Adapted from U.S National Library of Medicine PubMed Available from http://www.ncbi.nlm.nih.gov/sites/entrez Accessed August 21, 2009) Daniel H O’Leary et al Imaging of atherosclerosis: carotid intima–media thickness European Heart Journal (2010) 31, 1682–1689 Joseph F Polak, MD, MPH Measuring Carotid Intima-Media Thickness: Simple Protocols Have Advantages Journal of the American Society of Echocardiography Volume 25, Issue 10, Pages 1131–1134, October 2012 Sanne A.E Peters et al Measuring Carotid Intima-Media Thickness: Extensive Ultrasound Protocols Have Value Journal of the American Society of Echocardiography Volume 25, Issue 10, Pages 1128–1130, October 2012 John S Pellerito and Joseph F Polak Introduction to Vascular Ultrasonography, 6th Edition 2012, Elsevier Plaque and CHD Incidence: ARIC Study (Nambi et al., JACC 2010) Erling Falk & Prediman K Shah The SHAPE Guideline: Ahead of Its Time or Just in Time? Curr Atheroscler Rep DOI 10.1007/s11883-011-0195-y Springer Science+Business Media, LLC 2011 CÁM ƠN CÁC BỆNH NHÂN ĐÃ CHO TƠI NHỮNG HÌNH ẢNH VÀ CLIPS Q GIÁ CÁM ƠN SỰ CHÚ Ý THEO DÕI CỦA QUÝ BÁC SĨ Mũi Đại Lãnh – Phú Yên 10 December 2014 84 ... Atherosclerosis Springer-Verlag London Limited 2012 Quy trình khảo sát: 2.1 Đo đạc B mode Không đo Doppler màu B flow 2.2 CIMT cần phải đo lát cắt dọc, chùm tia siêu âm vng góc với thành mạch Thành