Intima-media thickness and carotid resistive index: progression over 6 years and predictive value for cardiovascular events.
OBJECTIVE
Intima-media thickness (IMT) of the common carotid artery and the resistive index (RI) of the internal carotid artery correlate with the degree of atherosclerosis and are predictors of cardiovascular morbidity and mortality. Limited or no data are available about long-term predictive values and the progression of the two markers themselves.


METHODS
145 patients with at least one cardiovascular risk factor or clinically manifest atherosclerosis were included. At enrollment and after 36 and 74 months, duplex sonographic measurements of IMT CCA and RI ICA were performed. During follow-up, the occurrence of cardiovascular events (cardiovascular death, myocardial infarction, stroke) was assessed.


RESULTS
At baseline, IMT was 0.79 +/- 0.16 mm and RI 0.66 +/- 0.08. Log-rank analysis showed a continuous increase in the risk of a cardiovascular event with an increasing range of IMT (p = 0.011) and RI (p = 0.006). IMT progression in patients with low versus high atherosclerotic burden (as defined by SMART score < or =7 points and > 7 points) differs significantly (32 +/- 83 microm versus 95 +/- 125 microm; p < 0.002). IMT progression was even more pronounced in patients suffering a cardiovascular event (141 +/- 105 microm versus 54 +/- 111 microm; p < 0.001). No significant RI ICA progression could be detected during follow-up in any group (patients with low vs. high atherosclerotic burden 0.00 +/- 0.06 versus 0.00 +/- 0.04; p = n. s.; patients with vs. without cardiovascular event 0.00 +/- 0.05 versus 0.01 +/- 0.03; p = n. s.).


CONCLUSIONS
Our results confirm the predictive value for cardiovascular events of RI and IMT in long-term follow-up. In contrast to RI, IMT increases over six years, above all in patients suffering a cardiovascular event. The results suggest that IMT is suitable for cardiovascular risk prediction as well as for progression measurements, while RI cannot be recommended for progression measurements. The effect of drug therapy on RI needs further clarification.
Department of Internal Medicine, Division of Angiology, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
H
H
Uthoff
D
D
Staub
A
A
Meyerhans
M
M
Hochuli
B
B
Bundi
H P
HP
Schmid
B
B
Frauchiger
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002339:Carotid Arteries / Q000473:pathology / Q000502:physiology*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D008055:Lipids / Q000097:blood; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D017539:Tunica Intima / Q000473:pathology / Q000502:physiology*; D017540:Tunica Media / Q000473:pathology / Q000502:physiology*; D018616:Ultrasonography, Doppler, Duplex; D014655:Vascular Resistance / Q000502:physiology*; D014664:Vasodilation; D055815:Young Adult
D008055:Lipids