The role of Carotid Intima-Media Thickness (CIMT) Measurement and Echo-tracking in the Assessment of Preclinical Carotid Artery Atherosclerosis in HIV-infected Patients

Abstract

Kardiovaskularne bolesti se sve češće pojavljuju kao značajan uzrok morbiditeta i mortaliteta u HIV-om zaraženih bolesnika koji uzimaju antiretrovirusne lijekove (ARL). Ta se pojava različito objašnjava, kao posljedica toksičnosti ARL-a, imunodeficijencije i/ili upale uzrokovane HIV-om. Mjerenje debljine intime-medije (IMT) karotidnih arterija B-mod ultrazvukom je važan čimbenik u procjeni ranog stadija ateroskleroze. Pretklinička ateroskleroza karotidnih arterija može se mjeriti brojem i površinom aterosklerotskih plakova i određivanjem arterijske krutosti. Beta indeks krutosti je jedan od često korištenih kliničkih markera ateroskleroze. Echo-tracking je nova ultrazvučna tehnologija koja koristi radio-frekvencijski signal za dobivanje visoke rezolucije od 0,01 mm uz transmisiju i prijem putem linearne ultrazvučne sonde visoke frekvencije od 10 MHz. Ta tehnologija ne troši puno vremena i koristi se u procjeni arterijske krutosti. Na Odjelu za radiologiju i ultrazvuk Klinike za infektivne bolesti „Dr. Fran Mihaljević“ u Zagrebu, u suradnji s HIV/AIDS centrom, započeli smo s kontinuiranim mjerenjem karotidnog IMT-a i površine i broja aterosklerotskih plakova u HIV-om zaraženih bolesnika od srpnja 2009. Također smo echo-trackingom pregledali skupinu HIV-om zaraženih bolesnika visokorizičnih za razvoj kardiovaskularnih i cerebrovaskularnih oboljenja. U našem ćemo prospektivnom istraživanju procjenjivati zamjenske markere ateroskleroze koji mogu uspješno identificirati i opisati HIV-om zaraženu populaciju s visokim rizikom razvoja kardiovaskularnih bolesti i utvrditi terapijske postupke.Cardiovascular (CV) disease has progressively emerged as a significant cause of morbidity and mortality among HIV-infected patients treated with combination antiretroviral therapy (cART). This has been variably attributed to cART toxicity, immunodeficiency and/or HIV-associated inflammation. Carotid intima-media thickness (CIMT) measurement by B-mod ultrasound is an important tool for evaluation of early stages of atherosclerosis. Subclinical atherosclerosis of carotid arteries can also be detected by measuring the number and area of present plaques and arterial stiffness assessment. Beta stiffness index is one of the most commonly used clinical markers of atherosclerosis. Echo-tracking is a new ultrasound technology that uses a radio frequency signal to provide high accuracy of 0.01 mm resolution at 10 MHz transmision/reception. Echo-tracking is a non-time consuming tool for diagnostic routine evaluation of arterial stiffness parameters. From July 2009, in collaboration with the HIV/AIDS Center, we started with a continuous CIMT and plaque area measurements in HIV-infected patients at the Department of Radiology and Ultrasound of the University Hospital for Infectious Diseases „Dr. Fran Mihaljević“ in Zagreb. We also used the echo-tracking to examine a group of HIV-infected patients who are at high-risk for CV diseases. In our prospective research we shall try to assess surrogate markers for atherosclerosis that can efficiently identify and describe HIV-infected population at high risk for CV disease development and investigate therapeutic regimens