Abstract
Purpose: Carotid artery properties can be evaluated with high accuracy and reproducibility using multiple M-line ultrasound. However, the cost of multiple M-line-based imaging modalities and the extensive operator expertise requirements hamper the large-scale application for arterial properties assessment, particularly in resource-constrained settings. This study is aimed to assess the performance of a single M-line approach as an affordable and easy-to-use alternative to multiple M-line imaging for screening purposes.Methods: We used triplicate longitudinal common carotid artery (CCA) ultrasound recordings (17 M-lines covering about 16 mm, at 500 frames per second) of 500 subjects from The Maastricht Study to assess the validity and reproducibility of a single against multiple M-line approach. The multiple M-line measures were obtained by averaging over all available 17 lines, whereas the middle M-line was used as a proxy for the single M-line approach.Results: Diameter, intima-media thickness (IMT), and Young's elastic modulus (YEM) were not significantly different between the single and multiple M-line approaches (p > 0.07). Distension and distensibility coefficient (DC) did differ significantly (p < 0.001), however, differences were technically irrelevant. Similarly, Bland-Altman analysis revealed good agreement between the two approaches. The single M-line approach, compared to multiple M-line, exhibited an acceptable reproducibility coefficient of variation (CV) for diameter (2.5 vs. 2.2%), IMT (11.9 vs. 7.9%), distension (10 vs. 9.4%), DC (10.9 vs. 10.2%), and YEM (26.5 vs. 20.5%). Furthermore, in our study population, both methods showed a similar capability to detect age-related differences in arterial stiffness.Conclusion: Single M-line ultrasound appears to be a promising tool to estimate anatomical and functional CCA properties with very acceptable validity and reproducibility. Based on our results, we might infer that image-free, single M-line tools could be suited for screening and for performing population studies in low-resource settings worldwide. Whether the comparison between single and multiple M-line devices will yield similar findings requires further study.
Highlights
Cardiovascular (CV) diseases are the leading cause of global mortality
The multiple M-line approach was considered as a reference against which we evaluated the performance of the single Mline approach
Reproducibility statistics were calculated based on three repeated measurements
Summary
Cardiovascular (CV) diseases are the leading cause of global mortality. The rate of CV deaths in LMI countries has remained constant, mainly driven by the low detection rate of early-stage CV diseases in these regions (Jagannathan et al, 2019). Arterial stiffness is recognized as an important predictor of CV diseases at their early stages. By contributing to elevated systolic blood pressure and increased cardiac afterload, an increased arterial stiffness causes CV diseases (Engelen et al, 2015). Increased arterial stiffness is associated with an enhanced risk of coronary heart disease, cerebrovascular events, and all-cause mortality (Laurent et al, 2001; Mattace-Raso et al, 2006; Karras et al, 2012; Steinbuch et al, 2016)
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