ReviewIntima media thickness measurement in children: A statement from the Association for European Paediatric Cardiology (AEPC) Working Group on Cardiovascular Prevention endorsed by the Association for European Paediatric Cardiology
Introduction
Atherosclerosis starts in childhood leading to cardiovascular disease in the adult patient [1], [2]. Thus, early recognition of vascular changes to prevent cardiovascular sequelae is warranted [3]. One of the most commonly used non-invasive diagnostic methods is measurement of the Intima-Media-Thickness of the common carotid artery by ultrasound. Following the initial consideration as a surrogate marker for atherosclerosis (cIMT: carotid Intima-Media-Thickness), recent meta-analyses raised questions about the usefulness for the assessment of the vascular status in adult patients. Moreover, including carotid plaque screening seems to add valuable informations for the prediction of cardiovascular events more than IMT measurement alone in the adult patient [4], [5], [6]. In children, several issues have to be considered. For example, patient preparation and technical equipment deserve special attention. Also, cIMT values have to be compared to age and sex-specific normative data. Thus, the Association for European Paediatric Cardiology (AEPC) Working Group on Cardiovascular Prevention suggests harmonising the cIMT acquisition and measurement methods and proposes a standardized examination protocol, which will be presented in the following.
Section snippets
Background
Starting from 1986, the sonographic evaluation of Intimal-Medial-Thickening of the common carotid arteries has gained scientific and clinical significance [7]. In past years, cIMT measurement has been considered a surrogate marker of atherosclerosis [8]. Moreover, it seemed to be useful for the prediction of clinical cardiovascular events. Recent meta-analyses, however, concluded that IMT measurement alone could not predict cardiovascular events and showed that including carotid plaque
Patient selection
In adult patients, cIMT measurement reflects the single patient's vascular status. It seems wise to include in cIMT measurement programs all those paediatric patients at elevated cardiovascular risk [1], [3]. Following the definition of the American Heart Association Expert Panel on Population and Prevention Science, paediatric patients with elevated cardiovascular risk can be divided into three groups [1]. Patients with high cardiovascular risk are patients with homozygous familial
Limitations
Although the cIMT measurement is widely used and – due to its non-invasive character – can be applied easily in the outpatient setting, the overall advantage of early recognition of increased cIMT has to be proven so far. Several studies have addressed the usefulness of preventive strategies in reducing increased cIMT values [11], [27]. As the cIMT is considered a surrogate marker for atherosclerosis, a reduction in cIMT should indicate also a reduced risk for atherosclerosis. In adult
Summary and outlook
cIMT scanning and measurement offers noteworthy information about the cardiovascular risk if performed according to the requirements outlined in the present statement. Also for children, the cIMT may provide a reliable surrogate marker for vascular health. Considering the progression of vascular changes throughout live, it seems prudent to detect subclinical signs of arterial damage and atherosclerosis very early and relief atherosclerotic burden by preventive measures. Thus, especially in the
Conflict of interests
R. Dalla Pozza: None.
D. Ehringer-Schetitska: None.
P. Fritsch: None.
E. Jokinen: None.
A. Petropoulos: None.
R. Oberhoffer: None.
Acknowledgement
The authors want to appreciate the great contribution of J. Elmenhorst, B. Böhm and H. Weberruß (literature research); of V. Herceg-Cavrak (manuscript edition), and of R. Meijer, M. Bots and J. Stein (extern reviewers).
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