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

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Prognostic Value of Aortic Pulse Wave Velocity in

1678 Danes, 9.4yr follow up studyCirculation 2006;113;664

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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