Skip to main content
Erschienen in: CardioVasc 2/2012

25.04.2012 | Original- und Übersichtsarbeiten

Intima-Media-Dickenmessung

Status quo et quo vadis?

verfasst von: Dr. med. Marcus Bauer, Amir A. Mahabadi, Hagen Kälsch, Kaffer Kara, Tobias Weiss, Raimund Erbel

Erschienen in: CardioVasc | Ausgabe 2/2012

Einloggen, um Zugang zu erhalten

Abstract

Die Messung des Anstiegs der Intima-Media-Dicke in der Arteria carotis communis (carotid intima-media thickness: CIMT) ist eine wichtige Untersuchungsmethode zur Quantifizierung der subklinischen Atherosklerose.

Ihr signifikanter Zusammenhang mit traditionellen und nicht-traditionellen kardiovaskulären Risikofaktoren sowie harten koronaren Ereignissen, wie plötzlicher Herztod, akuter Myokardinfarkt und Schlaganfall, konnte in verschiedenen Studien gezeigt werden. Zusätzlich wird die CIMT-Messung bei pharmakodynamischen Untersuchungen, z. B. zur Beurteilung der Wirkung einer lipidsenkenden oder antihypertensiven Therapie eingesetzt. Die Messmethode wurde in den letzten Jahren immer wieder technisch verbessert, sodass mit genaueren Messdaten auch ihre Aussagekraft in der Prävention kardiovaskulärer Ereignisse verbessert werden konnte. Unterschiedliche Messprotokolle verhindern jedoch die Vergleichbarkeit der Studienergebnisse.

Neben der CIMT-Messung erlaubt die Ultraschalluntersuchung der hirnversorgenden Gefäße eine zusätzliche Aussage über Plaqueformationen, die im Rahmen der kardiovaskulären Risikostratifikation einen eigenen Stellenwert besitzen.

Allerdings ist trotz der nachgewiesenen Assoziation zwischen einer CIMT-Zunahme und Plaquebildung dem Ausmaß der Gefäßverkalkung in den Koronararterien, bis heute ein Rückschluss auf den Koronargefäßzustand nicht möglich.

Literatur
  1. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet 1997;349:1498–1504.PubMedView Article
  2. Berenson GS, Srinivasan SR, Bao W, Newman WP III; Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults: the Bogalusa Heart Study. N Engl J Med 1998;338:1650-1656.PubMedView Article
  3. Stary HC, Chandler AB, Glagov S, Guyton JR, Insull W Jr, Rosenfeld ME, Schaffer SA, Schwartz CJ, Wagner WD, Wissler RW. A definition of initial, fatty streak, and intermediate lesions of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation 1994;89:2462-78.PubMed
  4. Erbel R, Möhlenkamp S, Moebus S, Schmermund A, Lehmann N, Stang A, Dragano N, Grönemeyer D, Seibel R, Kälsch H, Bröcker-Preuss M, Mann K, Siegrist J, Jöckel KH; Heinz Nixdorf Recall Study Investigative Group. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol 2010;19;5617:1397-406.View Article
  5. Polonsky TS, McClelland RL, Jorgensen NW, et al. Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA 2010;303:1610 –16.PubMedView Article
  6. Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation 1986;74:1399-406.PubMedView Article
  7. Bauer M, Möhlenkamp S, Erbel R. Intima-media thickness as a surrogate for subclinical atherosclerosis. Herz 2007;32:372-8.PubMedView Article
  8. Liang Q, Wendelhag I, Wikstrand J, Gustavsson T. A multiscale dynamic programming procedure for boundary detection in ultrasonic artery images. IEEE Trans Med Imaging. 2000;19:127-42.PubMedView Article
  9. Sandrock M, Hansel J, Schulze J, Schmitz D, Niess A, Burkhardt H, Schmidt-Trucksaess A. Sequentially based analysis versus image based analysis of Intima Media Thickness in common carotid arteries studies - do major IMT studies underestimate the true relations for cardio- and cerebrovascular risk? Cardiovasc Ultrasound 2008;6:32.PubMedView Article
  10. Touboul PJ, Prati P, Scarabin PY, Adrai V, Thibout E, Ducimetière P. Use of monitoring software to improve the measurement of carotid wall thickness by B-mode imaging. J Hypertens Suppl. 1992 Jul;10(5):S37-41.PubMedView Article
  11. Naghavi M, Falk E, Hecht HS, Jamieson MJ, Kaul S, Berman D, Fayad Z, Budoff MJ, Rumberger J, Naqvi TZ, Shaw LJ, Faergeman O, Cohn J, Bahr R, Koenig W, Demirovic J, Arking D, Herrera VL, Badimon J, Goldstein JA, Rudy Y, Airaksinen J, Schwartz RS, Riley WA, Mendes RA, Douglas P, Shah PK; SHAPE Task Force. From vulnerable plaque to vulnerable patient--Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report. Am J Cardiol. 2006;98:2H-15H.PubMedView Article
  12. Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, Najjar SS, Rembold CM, Post WS; American Society of Echocardiography Carotid Intima-Media Thickness Task Force. 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. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr 2008;21:93-111.PubMedView Article
  13. Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein N, Csiba L, Desvarieux M, Ebrahim S, Fatar M, Hernandez Hernandez R, Jaff M, Kownator S, Prati P, Rundek T, Sitzer M, Schminke U, Tardif JC, Taylor A, Vicaut E, Woo KS, Zannad F, Zureik M. Mannheim carotid intima-media thickness consensus (2004-2006). An update on behalf of the Advisory Board of the 3rd and 4th Watching the Risk Symposium, 13th and 15th European Stroke Conferences, Mannheim, Germany, 2004, and Brussels, Belgium, 2006. Cerebrovasc Dis 2007;23:75-80.PubMedView Article
  14. Greenland P, Abrams J, Aurigemma GP, Bond MG, Clark LT, Criqui MH, Crouse JR 3rd, Friedman L, Fuster V, Herrington DM, Kuller LH, Ridker PM, Roberts WC, Stanford W, Stone N, Swan HJ, Taubert KA, Wexler L. Prevention Conference V: Beyond secondary prevention: identifying the high-risk patient for primary prevention: noninvasive tests of atherosclerotic burden: Writing Group III. Circulation 2000;101:E16-22.PubMed
  15. Bauer M, Möhlenkamp S, Erbel R. Intima-media thickness is a suitable surrogate marker for systemic atherosclerosis - pro. Dtsch Med Wochenschr 2009;134:2006.PubMedView Article
  16. Künzli N, Perez L, von Klot S, Baldassarre D, Bauer M, Basagana X, Breton C, Dratva J, Elosua R, de Faire U, Fuks K, de Groot E, Marrugat J, Penell J, Seissler J, Peters A, Hoffmann B. Investigating air pollution and atherosclerosis in humans: concepts and outlook. Prog Cardiovasc Dis 2011;53:334-43.PubMedView Article
  17. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 2007;115(4):459-67.PubMedView Article
  18. Iglesias del Sol A, Bots ML, Grobbee DE, Hofman A, Witteman JC. Carotid intima-media thickness at different sites: relation to incident myocardial infarction; the Rotterdam Study. Eur Heart J. 2002;23:934–940.PubMedView Article
  19. O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999;340:14 –22.PubMedView Article
  20. Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation. 1997;96:1432–1437.PubMed
  21. Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR, Clegg LX. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol. 1997;146:483– 494.PubMedView Article
  22. Folsom AR, Kronmal RA, Detrano RC, O'Leary DH, Bild DE, Bluemke DA, Budoff MJ, Liu K, Shea S, Szklo M, Tracy RP, Watson KE, Burke GL. Coronary artery calcification compared with carotid intima-media thickness in the prediction of cardiovascular disease incidence: the Multi-Ethnic Study of Atherosclerosis (MESA). Arch Intern Med 2008;168:1333-9.PubMedView Article
  23. Blaha MJ, Rivera JJ, Budoff MJ, Blankstein R, Agatston A, O'Leary DH, Cushman M, Lakoski S, Criqui MH, Szklo M, Blumenthal RS, Nasir K. Association Between Obesity, High-Sensitivity C-Reactive Protein >=2 mg/L, and Subclinical Atherosclerosis: Implications of JUPITER from the Multi-Ethnic Study of Atherosclerosis. Arterioscler Thromb Vasc Biol. 2011. [Epub ahead of print]
  24. Bauer M, Moebus S, Möhlenkamp S, Dragano N, Nonnemacher M, Fuchsluger M, Kessler C, Jakobs H, Memmesheimer M, Erbel R, Jöckel KH, Hoffmann B; HNR Study Investigative Group. Urban particulate matter air pollution is associated with subclinical atherosclerosis: results from the HNR (Heinz Nixdorf Recall) study. J Am Coll Cardiol. 2010;56:1803-8.PubMedView Article
  25. Lorenz MW, Schaefer C, Steinmetz H, Sitzer M. Is carotid intima media thickness useful for individual prediction of cardiovascular risk? Ten-year results from the Carotid Atherosclerosis Progression Study (CAPS). Eur Heart J. 2010;31:2041-8.PubMedView Article
  26. Simon A, Megnien JL, Chironi G. The value of carotid intima-media thickness for predicting cardiovascular risk. Arterioscler Thromb Vasc Biol 2010;30:182-5.PubMedView Article
  27. Terwey B, Gahbauer H, Montemayor M, Proussalis A, Zöllner G. B-image sonography of carotid bifurcation. Ultraschall Med 1984;5:10-201.View Article
  28. Meyer P, Strobel M. Intima Media Dicke-Messung. Medizinisch Wissenschaftliche Verlagsgesellschaft 2008;1:10.
  29. Kubale R, Stiegler H. Farbkodierte Duplexsonographie. Thieme-Verlag 2002;1;153-186.
  30. Bots ML, Evans GW, Riley WA, Grobbee DE. Carotid intima-media thickness measurements in intervention studies: design options, progression rates, and sample size considerations: a point of view. Stroke 2003;34:2985-94.PubMedView Article
  31. Roman MJ, Naqvi TZ, Gardin JM, Gerhard-Herman M, Jaff M, Mohler E; American Society of Echocardiography; Society for Vascular Medicine and Biology. American society of echocardiography report. Clinical application of noninvasive vascular ultrasound in cardiovascular risk stratification: a report from the American Society of Echocardiography and the Society for Vascular Medicine and Biology. Vasc Med. 2006 Nov;11:201-11.PubMedView Article
  32. Wendelhag I, Liang Q, Gustavsson T, Wikstrand J. A new automated computerized analyzing system simplifies readings and reduces the variability in ultrasound measurement of intima-media thickness. Stroke 1997;28:2195-200.PubMedView Article
  33. Freire CM, Ribeiro AL, Barbosa FB, Nogueira AI, de Almeida MC, Barbosa MM, Lana AM, e Silva AC, Ribeiro-Oliveira A. Comparison between automated and manual measurements of carotid intima-media thickness in clinical practice. Vasc Health Risk Manag 2009;5:811-7.PubMed
  34. Costanzo P, Perrone-Filardi P, Vassallo E, Paolillo S, Cesarano P, Brevetti G, Chiariello M. Does carotid intima-media thickness regression predict reduction of cardiovascular events? A meta-analysis of 41 randomized trials. J Am Coll Cardiol. 2010 Dec 7;56(24):2006-20.PubMedView Article
  35. Puchner S, Reiter M, Baros C, Minar E, Lammer J, Bucek RA. Assessment of intima-media thickness of carotid arteries: evaluation of an automated computer software. Neuroradiology 2008;50:849-53.PubMedView Article
  36. Seçil M, Altay C, Gülcü A, Ceçe H, Göktay AY, Dicle O. Automated measurement of intima-media thickness of carotid arteries in ultrasonography by computer software. Diagn Interv Radiol 2005;11:105-8.PubMed
  37. Cipriano C, Constans J, Gosse P, Bressolette L, Saïdani S, Conri C. Common carotid intima-media thickness: does it matter how it is measured. Int Angiol 2003;22:273-8.PubMed
  38. Bauer M, Möhlenkamp S, Lehmann N, Schmermund A, Roggenbuck U, Moebus S, Stang A, Mann K, Jöckel KH, Erbel R. The effect of age and risk factors on coronary and carotid artery atherosclerotic burden in males-Results of the Heinz Nixdorf Recall Study. Atherosclerosis. 2009;205:595-602.PubMedView Article
  39. Taylor AJ, Sullenberger LE, Lee HJ, Lee JK, Grace KA. Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2: a double-blind, placebo-controlled study of extended-release niacin on atherosclerosis progression in secondary prevention patients treated with statins. Circulation 2004;110:3512-7.PubMedView Article
  40. Touboul PJ, Vicaut E, Labreuche J, Acevedo M, Torres V, Ramirez-Martinez J, Vinueza R, Silva H, Champagne B, Hernandez-Hernandez R, Wilson E, Schargrodsky H; CARMELA Study Investigators. Common carotid artery intima-media thickness: the Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study results. Cerebrovasc Dis 2011;31:43-50.PubMedView Article
  41. Dogan S, Duivenvoorden R, Grobbee DE, Kastelein JJ, Shear CL, Evans GW, Visseren FL, Bots ML. Radiance 1 and 2 Study Groups. Completeness of carotid intima media thickness measurements depends on body composition: the RADIANCE 1 and 2 trials. J Atheroscler Thromb 2010;17:526-35.PubMedView Article
  42. Crouse JR 3rd, Raichlen JS, Riley WA, Evans GW, Palmer MK, O'Leary DH, Grobbee DE, Bots ML; METEOR Study Group. Effect of rosuvastatin on progression of carotid intima-media thickness in low-risk individuals with subclinical atherosclerosis: the METEOR Trial. JAMA. 2007 Mar 28;297(12):1344-53.
  43. Smilde TJ, Wollersheim H, Van Langen H, Stalenhoef AF. Reproducibility of ultrasonographic measurements of different carotid and femoral artery segments in healthy subjects and in patients with increased intima-media thickness. Clin Sci (Lond). 1997;93:317–324.
  44. Salonen JT, Salonen R. Ultrasonographically assessed carotid morphology and the risk of coronary artery disease. Arterioscler Thromb 1991;11:1245–9.PubMedView Article
  45. Chambless LE, Folsom AR, Clegg LX, et al. Carotid wall thickness is predictive of incident clinical stroke: the Atherosclerosis Risk In Communities (ARIC) study. Am J Epidemiol 2000;151:478–87.PubMedView Article
  46. http://www.recall-studie.uni-essen.de/
  47. Gossl M, Lerman LO, Lerman A. Frontiers in nephrology: early atherosclerosis--a view beyond the lumen. J Am Soc Nephrol. 2007 Nov;18(11):2836-42.PubMedView Article
  48. Bots ML, Baldassarre D, Simon A, de Groot E, O'Leary DH, Riley W, Kastelein JJ, Grobbee DE. Carotid intima-media thickness and coronary atherosclerosis: weak or strong relations? Eur Heart J. 2007 Feb;28(4):398-406.PubMedView Article
  49. Pasterkamp G, Schoneveld AH, van Wolferen W, Hillen B, Clarijs RJ, Haudenschild CC, Borst C. The impact of atherosclerotic arterial remodelling on percentage of luminal stenosis varies widely within the arterial system. A post-mortem study. Arterioscler Thromb Vasc Biol 1997;7:3057–3063.
  50. Newman AB, Naydeck BL, Sutton-Tyrrell K, et al. Relationship between coronary artery calcification and other measures of subclinical cardiovascular disease in older adults. Arterioscler Thromb Vasc Biol 2002;22(10):1674–9.PubMedView Article
  51. Davis PH, Dawson JD, Mahoney LT, Lauer RM. Increased carotid intimal-medial thickness and coronary calcification are related in young and middle-aged adults. The Muscatine study. Circulation 1999;100:838–42.
  52. Frostegard J: SLE, atherosclerosis and cardiovascular disease. J Intern Med 2005;257:485-495.PubMedView Article
  53. Roman MJ, Shanker BA, Davis A, Lockshin MD, Sammaritano L, Simantov R, Crow MK, Schwartz JE, Paget SA, Devereux RB, Salmon JE: Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. N Engl J Med 2003, 349:2399-2406.PubMedView Article
  54. Mangili A, Polak JF, Quach LA, Gerrior J, Wanke CA. Markers of atherosclerosis and inflammation and mortality in patients with HIV infection. Atherosclerosis 2011;214:468-73.PubMedView Article
  55. Soltész P, Kerekes G, Dér H, Szücs G, Szántó S, Kiss E, Bodolay E, Zeher M, Timár O, Szodoray P, Szegedi G, Szekanecz Z. Comparative assessment of vascular function in autoimmune rheumatic diseases: Considerations of prevention and treatment. Autoimmun Rev 2011;10:416-25.PubMedView Article
  56. Salonen R, Salonen JT. Progression of carotid atherosclerosis and its determinants: a population-based ultrasonography study. Atherosclerosis 1990;81:33–40.PubMedView Article
  57. Villines TC, Stanek EJ, Devine PJ, Turco M, Miller M, Weissman NJ, Griffen L, Taylor AJ. The ARBITER 6-HALTS Trial (Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol 6-HDL and LDL Treatment Strategies in Atherosclerosis): final results and the impact of medication adherence, dose, and treatment duration. J Am Coll Cardiol 2010;55:2721-6.PubMedView Article
  58. Taylor AJ, Villines TC, Stanek EJ, Devine PJ, Griffen L, Miller M, Weissman NJ, Turco M. Extended-release niacin or ezetimibe and carotid intima-media thickness. N Engl J Med. 2009;361:2113-22.PubMedView Article
  59. Vergeer M, Zhou R, Bots ML, Duivenvoorden R, Koglin J, Akdim F, Mitchel YB, Huijgen R, Sapre A, de Groot E, Sijbrands EJ, Pasternak RC, Gagné C, Marais AD, Ballantyne CM, Isaacsohn JL, Stalenhoef AF, Kastelein JJ. Carotid atherosclerosis progression in familial hypercholesterolemia patients: a pooled analysis of the ASAP, ENHANCE, RADIANCE 1, and CAPTIVATE studies. Circ Cardiovasc Imaging 2010;3:398-404.PubMedView Article
  60. Kastelein JJ, de Groot E. Ultrasound imaging techniques for the evaluation of cardiovascular therapies. Eur Heart J. 2008;29:849-58.PubMedView Article
  61. Kastelein JJ, Akdim F, Stroes ES, Zwinderman AH, Bots ML, Stalenhoef AF, Visseren FL, Sijbrands EJ, Trip MD, Stein EA, Gaudet D, Duivenvoorden R, Veltri EP, Marais AD, de Groot E; ENHANCE Investigators. Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med 2008;358:1431-43.PubMedView Article
  62. Brown BG, Taylor AJ. Does ENHANCE Diminish Confidence in Lowering LDL or in Ezetimibe? N Engl J Med 2008; 358:1504-1507.PubMedView Article
  63. Eleid MF, Lester SJ, Wiedenbeck TL, Patel SD, Appleton CP, Nelson MR, Humphries J, Hurst RT. J Am Soc Echocardiogr 2010;23:802-8PubMedView Article
  64. Elias-Smale SE, Kavousi M, Verwoert GC, Koller MT, Steyerberg EW, Mattace-Raso FU, Hofman A, Hoeks AP, Reneman RS, Witteman JC. Common carotid intima-media thickness in cardiovascular risk stratification of older people: the Rotterdam Study. Eur J Cardiovasc Prev Rehabil 2011 [e-pub ahead of print]
  65. Nambi V, Chambless L, He M, Folsom AR, Mosley T, Boerwinkle E, Ballantyne CM. Common carotid artery intima-media thickness is as good as carotid intima-media thickness of all carotid artery segments in improving prediction of coronary heart disease risk in the Atherosclerosis Risk in Communities (ARIC) study. Eur Heart J 2011 [e-pub ahead of print]
Metadaten
Titel
Intima-Media-Dickenmessung
Status quo et quo vadis?
verfasst von
Dr. med. Marcus Bauer
Amir A. Mahabadi
Hagen Kälsch
Kaffer Kara
Tobias Weiss
Raimund Erbel
Publikationsdatum
25.04.2012
Verlag
Urban and Vogel
Erschienen in
CardioVasc / Ausgabe 2/2012
Print ISSN: 1617-4933
Elektronische ISSN: 1618-3851
DOI
https://doi.org/10.1007/s15027-012-0084-5

Weitere Artikel der Ausgabe 2/2012

CardioVasc 2/2012 Zur Ausgabe

Original- und Übersichtsarbeiten

Diagnostik und Therapie der pulmonalen Hypertonie

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.