nih assessment for the mesa study n.
Skip this Video
Loading SlideShow in 5 Seconds..
NIH assessment for the MESA study PowerPoint Presentation
Download Presentation
NIH assessment for the MESA study

Loading in 2 Seconds...

play fullscreen
1 / 24

NIH assessment for the MESA study - PowerPoint PPT Presentation

  • Uploaded on

How to detect coronary heart disease. If the patient does not have chest pain ... Carotid IMT and future heart attacks and strokes in individuals with no symptoms ...

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'NIH assessment for the MESA study' - No1City

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
causes of death in the usa
Causes of death in the USA
  • Heart disease is number one
  • Newsweek, Jan 31 2000 (p. 49)
where does heart disease come from
Where does heart disease come from ?
  • Epidemiologic studies, e.g. the Framingham Heart Study
    • Linkage between “risk factors” and coronary artery stenosis
    • What is a risk factor ?
      • Elevated blood pressure
      • Elevated cholesterol
      • Cigarette smoke
how to detect coronary heart disease
How to detect coronary heart disease
  • If the patient has chest pain
    • Stress testing
    • Radionuclide imaging
    • Coronary catheterization
  • This is for “advanced disease”
how to detect coronary heart disease1
How to detect coronary heart disease
  • If the patient does not have chest pain
  • This is for early, possibly reversible disease
mesa multi ethnic study of atherosclerosis
MESAMulti-Ethnic Study of Atherosclerosis
  • NHLBI/NIH funded
  • Multi-center study:6 centers, 6500 participants
  • Risk factors for atherosclerosis
  • Non-invasive markers of atherosclerosis
    • Coronary calcium scoring
  • Progression of calcium scores
mesa multi ethnic study of atherosclerosis1
MESAMulti-Ethnic Study of Atherosclerosis
  • Ultrasound markers of atherosclerosis
    • Carotid IMT
    • Brachial artery reactivity (endothelial function)
    • Carotid artery distensibility
what is carotid imt
What is Carotid IMT ?

IMT: thickness of the intima to media interfaces seen on high resolution imaging of the arterial wall

carotid imt and future heart attacks and strokes in individuals with no symptoms











Carotid IMT and future heart attacks and strokes in individuals with no symptoms

Top 20% with thick IMTs

Combined IMT






5 times the chance of heart attack and stroke





Incidence Rates (1,000 person-years)









O’Leary, Polak, Kronmal et al.

NEJM 1999

Quintiles of IMT values

coronary artery physiology
Coronary artery physiology
  • Healthy coronary arteries should dilate when needed
  • Coronary reactivity is abnormal in patients with coronary disease
  • May represent a generalized dysfunction of the arterial system
brachial artery reactivity
Brachial artery reactivity
  • Brachial artery endothelial function parallels coronary response
  • Abnormal: less of an increase in diameter during stimulus
mesa ultrasound device selection
MESA: Ultrasound device selection
  • Goal: select an imaging device that will permit precise measurements of:
    • Level of wall thickening in the carotid artery: IMT
    • Changes in arterial diameter over time: brachial artery reactivity
mesa ultrasound device selection1
MESA: Ultrasound device selection
  • Acuson Aspen, Hewlett-Packard ImagePoint; Siemens Allegra; Toshiba Power Vision 8000; GE Logiq-700; ATL HDI-5000
  • Same sonographer, same subject
  • Operator: application specialist from the respective companies
mesa ultrasound device selection2
MESA: Ultrasound device selection
  • 2 of the 6 devices disqualified
    • Poor image quality
    • Insufficient frame rates
  • Unanimous decision by 6 representatives of the field centers
mesa ultrasound device selection3
MESA: Ultrasound device selection
  • Removal of identifying marks
  • Scaling to same magnification
  • Normalized image intensities (0 to 255; minimum to maximum)
  • Scoring as 1 (best) to 4 (worse)
  • Images transmitted by e-mail
mesa ultrasound device selection4
MESA: Ultrasound device selection
  • Image evaluation performed by:
    • 6 trained readers: perform the measurements
    • 6 representatives from the field centers
  • Scores tallied for
    • Carotid IMT near wall
    • Carotid IMT far wall
    • Brachial artery image clarity
mesa ultrasound device selection5
MESA: Ultrasound device selection
  • Brachial artery diameters
mesa ultrasound device selection9
MESA: Ultrasound device selection
  • Based on device ranking, the GE Logiq-700 was picked for MESA
  • The study has enrolled more than 2000 of 6500 individuals
  • Preliminary examination of data quality and completeness shows overall good performance for all imaging tasks
mesa ultrasound examination
MESA: Ultrasound examination
  • Unanswered questions:
    • Are coronary artery calcium scores superior to carotid IMT ?
    • Does endothelial dysfunction predict the development of coronary disease ?