Upload
others
View
5
Download
0
Embed Size (px)
Citation preview
How to Detect Arteriosclerosis and
Atherosclerosis in Clinic
Korea University Medical College
Shim Wan Joo
• Arteriosclerosis ; hardening of the arteries
• Atherosclerosis ; gruel hardening of the arteries
Methods to Detect Atherosclerosis and
Atherosclerosis
• Inflammatory marker
• Endothelial function evaluation
• Measurement of of arterial stiffness
• Atherosclerotic plaque imaging
Participation of Inflammation in all stages of Atherosclerosis
Proposed Inflammatory Mediators to
Predict future cardiac Events
• IL -6
• TNF - α
• Soluble ICAM-1, P selectin, E selectin
• CRP
• fibrinogen
• serum amylod A
Prospective studies of HSCRP as a marker for future cardiovascular events
among individuals without known coronary disease Circulation 2001;103;1813
http://circ.ahajournals.org/content/vol103/issue13/images/large/hc1315243001.jpeg
Techniques for Assessing Endothelial
Function
• Coronary artery ;
intracoronary infusion of actylcholine
cold pressor test
• Peripheral circulation;
brachial artery reactivity
venous occulusion plethysmography
http://circ.ahajournals.org/content/vol109/23_suppl_1/images/large/6FF1.jpeg
Circulation. 2003;107:3243.)
Flow- Mediated Vasodilation of the
Brachial Artery
• Fasting for 8 to 12 hours
• Withhold vasoactive drugs at least 4 half lives
• Minimun 7 MHz transducer
• Simultaneous EKG recording
• Bp cuff - 50mmHg above systolic pressure
• Longitudinal imaging of brachial artery before
and after deflation
Am J Cardio 200;86 ,207
Prognostic Value of Flow -mediated Dilation of the Brachial
Artery with Angina Pectoris
Responses of Coronary Artery Diameter to the
Intracoronary Acetycholine
JKMS 2005 Apr; 20 (2): 204
Coronary Flow Reserve and Coronary Vascular Resistance
Index after Cold Stimulation
Pulse Pressure
• Depends on
left ventricular ejection
properties of the arterial wall
transmission characteristics
of the arterial system
Relationship between Pulse Pressure
and Atherosclerosis
Pulse pressure: a predictor of long-term cardiovascular mortality
in a French male population.
Aortic Pulse Wave Velocity
• Increased when aortic stiffness increases
• Increased in old age
smoking
hypertension
diabetes
hyperlipidemia
Simultaneous recording of carotid pulse wave, phonocardiogram
and femoral wave
ROC curve ; Aortic pulse wave velocity in detection of patient
with high 10 year cardiovascular mortality
62% sensitivity, 67% specificity,
39% positive predictive value, 84% negative predictive value when
PWV is > 13 m/sec Hypertension 1999;33;1111
http://hyper.ahajournals.org/content/vol33/issue5/images/large/hy0490890002.jpeg
Prognostic Value of Aortic Pulse Wave Velocity in
1678 Danes, 9.4yr follow up studyCirculation 2006;113;664
http://circ.ahajournals.org/content/vol113/issue5/images/large/14FF1.jpeg
Augmentation Index
• Composite of pulse wave velocity and wave
reflection
• Radial augmentation index
Aortic augmentation index
Increased aortic stiffness
Increased pulse wave velocity
Early return of wave reflection
Augmentation of systolic pressure
Odd Ratio of Coronary Artery disease According to Augmentation Index
In 465 Males who Underwent Coronary Angiography
Atherosclerotic Plaque Imaging
• Cardiac computed tomography
• Carotid artery intima-media thickness
• Cardiovascular magnetic resonance imaging
• Intravascular ultrasonography