Abstract
Intima-media thickness (IMT) of the carotid artery is defined as a double layer visible
in B-mode ultrasound as part of the arterial wall. Due to its low measurement variability
(intra- and inter-observer) and high visibility, the measurement is strongly recommended
in the most distal part of the common carotid artery. Reading should preferably be
done by automated tracing because it shows significantly lower reading variability
than manual procedures. In addition, in depth training is a prerequisite for reproducible
and reliable IMT measurements.
IMT increases linearly with age and is concordantly associated with most of the atherosclerotic
risk factors responsible for cardio-vascular events, i. e. myocardial infarction or
stroke. In addition, IMT of the carotid arteries is an independent predictor of cardio-vascular
events, even after adjustments for atherosclerotic risk factors. IMT measurements
of the carotid tree are most useful for assessing CVD risk in intermediate risk patients
and special risk groups. Plaques in the carotid tree and IM thickening are independent
atherosclerotic processes. IM thickening may occur early in life, at which point plaques
are not yet visible. Both contribute independently to the risk assessment of future
cardio-vascular events.
Kernaussagen
-
Die Messung der Intima-Media-Dicke der Karotiden ist sicher, kostengünstig und verlässlich
einsetzbar, um die atherosklerotische Last abzuschätzen.
-
Die IMT leistet einen unabhängigen Beitrag zur Abschätzung des kardiovaskulären Risikos
bei asymptomatischen Patienten mit klassischen atherosklerotischen Risikofaktoren.
-
Die IMT steigt auch bei Gesunden mit zunehmendem Lebensalter an. Diese altersbezogene
Progression ist von beschleunigter Progression durch eine erhöhte Risikofaktorenbelastung
oder manifeste atherosklerotische Erkrankung abzugrenzen.
-
Wegen der besten Sichtbarkeit, der Einfachheit der Messung, der besten Reproduzierbarkeit
und vergleichbarer prädiktiver Bedeutung wie im restlichen Karotisbaum sollte die
IMT vorzugsweise im distalen Zentimeter der A. carotis communis gemessen werden.
-
Mindestvoraussetzung für die Messung ist ein 7,5 MHz linearer Schallkopf mit einer
Breite von mindestens 3 cm.
-
Die Standards der Messung sind strikt einzuhalten, um reproduzierbare und vergleichbare
Messwerte zu erhalten.
-
Unter den Analysemethoden der IMT haben die automatisierten Methoden die größte Reproduzierbarkeit
und den kleinsten Lesefehler.
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Prof. Dr. med. Arno Schmidt-Trucksäss
Ordinarius für Sportmedizin
Institut für Sport und Sportwissenschaften, Bereich Sportmedizin
Medizinische Fakultät, Universität Basel
Birsstr. 320B
CH Basel 4052
Email: arno.schmidt-trucksaess@unibas.ch
