Carotid Arterial Strain Research Articles

Safety of Shear Wave Elastography as Evidenced From Carotid Artery Strain and Strain Rate Induced by Acoustic Radiation Force Impulse and Arterial Pulsations.

The aim of this study was to investigate the mechanical effects of carotid shear wave elastography (SWE) in vivo as its effects on the arterial wall have not been thoroughly examined. We evaluated the mechanical effects of carotid SWE in vivo in terms of the radial strain and strain rate to which acoustic radiation force impulses (ARFIs) expose the arterial wall, and compared them with the strain and strain rate induced by arterial pulsation in 13 healthy study subjects (seven individuals 20-35 y of age and six individuals 50-65 y of age). Additionally, we explored whether mechanical effects vary with timing of ARFI and subject age. The young cohort was found to have, compared with the old cohort, a higher diastolic ARFI-induced peak strain (p = 0.002) and peak strain rate (p = 0.001), and a lower diastolic ARFI-induced peak negative strain rate (p = 0.013). When comparing cardiac phases, diastolic ARFIs were found to induce a lower peak negative strain rate than systolic ARFIs (p = 0.006). Importantly, ARFI-induced peak strain was lower than that caused by arterial pulsation in both age cohorts (p < 0.0001). The ARFI-induced peak strain rate was slightly higher than that caused by arterial pulsation at rest but lower than published exercise data. The ARFI-induced peak negative strain rate was similar to that caused by arterial pulsation. Our results indicate that arterial SWE does not expose the arterial wall to any higher strain or strain rate than is experienced during normal arterial pulsation. Further research is required to validate the results in arteries containing vulnerable plaques.

Resistance- and endurance-trained young men display comparable carotid artery strain parameters that are superior to untrained men

PurposeCentral arterial stiffness, a predictor of cardiovascular risk, attenuates with endurance-exercise in ageing populations. However, in young individuals, this effect is inconsistent and emerging evidence suggests resistance-exercise may increase arterial stiffness. Two-dimensional (2D)-Strain imaging of the common carotid artery (CCA) is more sensitive at detecting endurance-training induced alterations in CCA stiffness than conventional methods, but has not been used to examine CCA stiffness in young resistance-trained individuals. Therefore, we compared CCA 2D-Strain parameters at rest, during acute exercise and recovery between resistance-trained, endurance-trained, and untrained young men.MethodsShort-axis CCA ultrasound images were obtained from 12 endurance-trained [27yrs (95%CI; 24–29)], 14 resistance-trained [24yrs (23–26)] and 12 untrained [23yrs (22–24] men at rest, during isometric handgrip (IHG) exercise and recovery. 2D-Strain analysis quantified CCA peak circumferential strain (PCS) and systolic (S-SR) and diastolic (D-SR) strain rates. Conventional stiffness indices included aortic pulse-wave velocity, CCA β-stiffness (β1) and Petersons elastic modulus (Ep).ResultsResting conventional stiffness indices were not different between groups (P > 0.05). Resting PCS and S-SR were comparable between resistance- [11.6% (10.6–12.5) and 1.46 s−1 (1.37–1.55), respectively] and endurance-trained [11.4% (10.7–12.2) and 1.5 s−1 (1.38–1.62)] men and superior to untrained men [9.5% (9.19–9.9); P < 0.004 and 1.24 s−1 (1.17 – 1.31); P < 0.018)]. Both trained groups displayed comparable reductions in PCS and S-SR during IHG, which returned to resting values during recovery (P < 0.001), whereas these parameters remained unchanged in untrained men. D-SR decreased during IHG in all groups (P < 0.001), but to a lesser extent in endurance-trained men (P < 0.023), whereas β1 and Ep increased to a similar magnitude in all groups and returned to resting values during recovery (P < 0.001).ConclusionResistance- and endurance-trained men display comparable CCA 2D-Strain parameters that are superior to untrained men, which contends previous reports that resistance-training increases CCA stiffness.

Carotid wave analysis in young adults with a history of adolescent anorexia nervosa: a case control study

BackgroundAnorexia nervosa (AN) is associated with abnormalities that may increase the risk of future cardiovascular disease. This study assessed the cardiovascular health of individuals who recovered from AN during adolescence by conducting wave power analysis.MethodsFormer AN patients discharged from the Royal Children’s and Monash Children’s Hospitals (N = 17) in Melbourne, Australia underwent ultrasound imaging of the right carotid artery. Wave power analysis was conducted to assess biomechanical interactions of the cardiovascular system. Patient measures were compared to healthy controls (N = 51).ResultsEighty-eight percent of the former AN patients and controls were female, aged approximately 25 years, with a healthy body mass index. Mean carotid flow and pulsatility index were not different between groups. Carotid arterial strain and distensibility were lower, and the wave speed and beta stiffness index higher in the former AN patients. Characteristic impedance was not different nor were the forward and backward wave amplitudes. However, wave reflection indices (ratios of backward-to-forward compression wave area, and wave-related effect on pressure and hydraulic power) were 12–18% lower in the former AN patients (p < 0.05).ConclusionsIncreased carotid artery stiffness and reduced wave reflection are evident in young adults who recovered from adolescent AN. This may relate to an adaptive process that helps to maintain or restore flow and characteristic impedance despite increased vessel stiffness, with this warranting future investigation.

Carotid Stiffness After Transcatheter Aortic Valve Replacement.

The present study aimed to analyze common carotid artery strain properties in patients (n = 59) with severe aortic valve stenosis who underwent transcatheter aortic valve replacement (TAVR). Arterial compliance of the common carotid artery was assessed by ultrasound speckle-tracking before and after TAVR. For sub-analysis the study cohort was divided according to aortic valve area <.75cm2 (n = 30) vs ≥.75cm2 (n = 29). Comparison of pre- and post-procedural strain variables showed an improvement in median radial velocity (P < .0001), radial displacement (P = .007), circumferential strain (P = .004), radial strain rate (P = .023), and circumferential strain rate (P < .0001), while the increase of radial strain showed a trend (P = .082). Analysis of aortic valve area revealed an inverse correlation between aortic valve area and the differences (post-procedural-pre-procedural values) for radial strain rate, and circumferential strain. Moreover, sub-analysis revealed that the increase of carotid strain variables before and after TAVR were more pronounced in the sub-group of aortic valve area .75 vs ≥.75cm2. TAVR led to a reduction of arterial wall stiffness of the common carotid artery assessed by ultrasound speckle-tracking. The decrease of arterial wall stiffness after TAVR was more pronounced in more severe aortic valve stenosis.

Habitual exercise influences carotid artery strain and strain rate, but not cognitive function in healthy middle-aged females

PurposeAging females are at risk of declining vascular and cognitive function. Exercise can augment both factors independently; however, the influence of exercise on their interdependence is less clearly understood. Ultrasound speckle tracking is a sensitive novel measure of arterial aging but has not previously been used in middle-aged females. We aimed to elucidate the potential interactions between vascular and cognitive variables in active aging females.MethodsTwelve active (56 ± 5 years; {dot{mathrm{V}}mathrm{O}}_{2mathrm{peak}}: 34.5 ± 6.1 ml.kg.min−1) and 13 inactive (57 ± 4 years; 22.8 ± 2.6 ml.kg.min−1) healthy middle-aged females were included. Ultrasound speckle tracking assessed short-axis common carotid artery (CCA) compliance via peak circumferential strain (PCS) and strain rate (PSR) at rest, during, and after 3-min isometric handgrip exercise. Flow-mediated dilation (FMD) of the brachial artery was assessed using ultrasound. Cognitive function was measured using Verbal Fluency, Trail Making, Stroop, and Digit Span tests.ResultsPCS (P = 0.003) and PSR (P = 0.004), were higher in the active cohort. FMD was similar between groups (P > 0.05). Minimal differences in cognitive function existed between groups, although the inactive group performed better in one test of animal Verbal Fluency (P < 0.01). No associations were observed between PCS, PSR, or FMD with cognitive function (all P > 0.05).ConclusionThis is the first study to assess PCS and PSR in middle-aged females and demonstrates that active middle-aged females exhibit a superior carotid artery profile compared to their inactive counterparts. However, PCS and PSR of the carotid artery may not be linked with cognitive function in middle-aged females.

Hypertension in individuals working in the Arctic on a rotating basis: relationship of arterial stiffness with inflammatory markers and some metabolic risk factors

Aim. To assess the relationship of arterial stiffness, inflammatory markers, some metabolic risk factors, including gender-specific aspects, in hypertensive (HTN) patients working in the Arctic on a rotating basis.Material and methods. In the polar settlement of Yamburg (68 21’ 40" northern latitude), on the basis of the medical unit of OOO YaGD, 99 men (M) and 81 women (F) with grade 1-2 HTN (61 M and 44 F) and normotensive individuals (HTN0) were examined. Patients with HTN were comparable in terms of age (p=0,68), number of rotation work years (p=0,7701), office systolic BP (p=0,473), diastolic BP (p=0,6992), and body mass index (p=0,465). We carried out 24-hour BP monitoring, common carotid artery ultrasound with the calculation of local stiffness parameters (distensibility coefficient, stiffness index, Peterson’s elastic modulus (Ep), Young’s elastic modulus (Eу)); pulse wave velocity (PWV) was studied. In addition, biochemical blood tests with the determination of high-sensitivity C-reactive protein, homocysteine, C-peptide, insulin, cortisol, atrial natriuretic peptide, interleukins (IL-1β, IL-6, IL-8, IL-10), tumor necrosis factor (TNF-α).Results. In groups M and F with HTN, in comparison with HTN0, higher values of following vascular stiffness parameters were revealed: group F — pulse pressure (p=0,018), intima-media thickness (p=0,0077), PWV (p&lt;0,00001), Eу (p=0,0314); group M — PWV (p=0,0004), Eу (p=0,0024) and reduced common carotid artery strain (p=0,0131). In M with HTN, in comparison with F with HTN, intima-media thickness (p=0,0008), stiffness index (p=0,0368), Ep (p=0,051) were higher. PWV in M and F with HTN was determined significantly higher than in persons with normal BP (p=0,0007; p=0,0001). Correlation analysis revealed the relationship between PWV and 24-hour blood pressure monitoring in hypertensive men and women. An increase in PWV per unit of measurement in women increases the HTN probability by 1,7 times, in men — by 1,4 times. Compared with HTN0 group, the levels of C-peptide (p=0,032), insulin (p=0,035), IL-1β (p=0,025), cortisol (p=0,031) in M group were significantly higher, while significantly higher levels of C-peptide (p=0,015), insulin (p=0,012), IL-6 (p=0,021), TNF-α (p=0,047) were revealed in F group. Stepwise logistic regression analysis revealed following independent parameters affecting the HTN probability: M group — PWV (odds ratio (OR) 1,554 (95% confidence interval (CI): 1,058-2,281, p=0,025)), C-peptide (OR 1,186 (95% CI: 1,004-1,588, p=0,022)), IL-1β (OR 1,464 (95% CI: 0,936-2,291, p=0,099)); F group — PWV (OR 2,015 (95% CI: 1,319-3,078, p=0,001)), C-peptide (OR 2,133 (95% CI: 1,236-3,680, p=0,006)), IL-6 (OR 2,101 (95% CI: 1,003-4,400, p=0,049)) and reduced TNF-α level (OR 0,801 (95% CI: 0,668-0,959, p=0,016)).Conclusion. Under the rotation work conditions in the Arctic, high vascular stiffness values, regardless of sex, are associated with HTN. In men, regardless of BP level, vascular stiffness parameters were higher. However, a stronger association of vascular stiffness with the HTN risk was observed in women. In hyper­tensive patients in the Arctic, an association of vascular stiffness with nonspecific immune inflammation factors was found, which was more pronounced in women. In addition to vascular stiffness and pro-inflammatory cytokines, the "northern" HTN model includes C-peptide, which is an atherosclerosis modulator.

Abstract 12894: Murine Arterial Wall Strain Estimation With Ultrasound-Based Lagrangian Carotid Strain Imaging and Validation Against Histological Findings

Introduction: Early identification of arterial injury by non-invasive imaging can facilitate research into mechanisms of arterial injury and has the potential to improve patient management. We tested the hypothesis that Lagrangian carotid strain imaging (LCSI) combined with adaptive Bayesian regularization could detect early arterial injury and monitor atherogenesis in a murine model by associating findings with histological examinations. Methods: Radio-frequency (RF) data were collected from the right and left common carotid arteries (CCA) of 10 (5 male and 5 female) ApoE tm1Unc/J mice at 6, 16 and 24 weeks using a high frequency ultrasound system. Cumulative axial, lateral and shear strain images were estimated using LCSI and 3 strain indices: maximum accumulated strain index (MASI), peak mean strain of full ROI index (PMSRI) and strain at peak axial displacement index (SPADI). Mice were euthanized (n=2 at 6 and 16 weeks, n=6 at 24 weeks) for histological examination. Results: We observed sex-specific differences in the temporal variation of strain indices. For male mice, axial PMSRI and SPADI changed significantly from 6 to 24 weeks (mean axial SPADI at 6 = 14.10±6.30 % and 24 weeks = 0.24±6.22%; p=0.0004). For female mice, lateral MASI was significantly higher at 24 than 6 weeks (mean lateral MASI at 6 = 10.26±3.13 % and 24 weeks = 16.42±7.15% p=0.048). Both sexes had strong associations with histological findings. For males, axial PMSRI and SPADI showed significant correlation with the number of elastin fibers (axial PMSRI: r s =0.83, p=0.01; axial SPADI: r s =0.76, p=0.02). For females, lateral and shear MASI had significant correlations with plaque scores (lateral MASI: r s =0.66, p=0.04; shear MASI: r s 0.77, p =0.009). Conclusions: LCSI can quantify carotid arterial wall strain in a murine model non-invasively. Changes in strain were associated with changes in arterial wall microstructure after plaque formation.

The predictive value of carotid artery strain and strain-rate in assessing the 3-year risk for stroke and acute coronary syndrome in patients with metabolic syndrome

Abstract Purpose The goal of this study is to see if carotid strain and strain rate can predict major cardio-vascular events (MACE) in people who have metabolic syndrome (MS) over a 3-year period of time. Methods In this prospective observational research, we enrolled 220 adult MS patients (60.7±7.5 years old, 53% male). Bilateral 2D common carotid carotid artery (CCA) speckle-tracking ultrasound was used to determine the peak circumferential strain (CS) and the peak circumferential strain rate (CSR). Clinical outcomes were assessed throughout a three-year follow-up period. Results After a 3-year follow-up period follow-up, 14 (7%) experienced MACE: Eight (4%) suffered an atherothrombotic ischemic stroke, four (2%) had acute coronary syndrome, and two (1%) were hospitalized for heart failure. Univariate regression analysis of the clinical and echocardiographic features of the MS patients found that age, systemic hypertension, diabetes mellitus, and the CCA circumferential strain and strain rate were significantly associated with the risk of MACE. Multivariate logistic regression identified two independent predictors of MACE in patients with MS, namely the CCA-related CS (%) and CSR (1/s), P&amp;lt;0.01. The ROC curve analyses of these independent predictors of MACE indicated appropriate sensitivities and specificities. CS (AUC = 0.806, sensitivity = 82.6%, specificity = 79.2%, P&amp;lt;0.0001); CSR (AUC = 0.779, sensitivity = 82.6%, specificity = 72.4%, P&amp;lt;0.0001). The cut-off values were ≤2.9% for carotid CS and ≤0.35 s–1 for carotid CSR. Using these cut-off values, we obtained Kaplan-Meier survival curves, and these showed that MACE, ischemic stroke, and ACS-free survival was significantly lower among the MS patients with lower carotid CS and CSR (P&amp;lt;0.0001). Conclusion Carotid CS and CSR were independent predictors of major cardio- and cerebrovascular events in prospectively monitored MS patients without established cardiovascular disease. Carotid deformation could be valuable as an early prognostic indicator for the cardiovascular risk in this population group. Funding Acknowledgement Type of funding sources: None.

The effect of aging on carotid artery wall mechanics during maximal resistance exercise.

Age-related stiffening of the large elastic arteries (e.g., common carotid artery [CCA]) may impair wall dynamics (i.e., strain) and amplify transmission of pulsatile blood flow into the brain with large increases in pressure that occur during maximal resistance exercise (RE). The purpose of this study was to compare CCA arterial wall dynamics, central hemodynamics, and cerebral blood velocity responses during maximal RE between young and older adults. Thirty-one young (YA; 26 ± 5 yrs; 23.8 ± 3.3kg/m2) and 25 older adults (OA; 60 ± 6 yrs; 30.0 ± 5.5kg/m2) performed a unilateral maximal isokinetic knee flexion/extension exercise protocol (i.e., maximal RE). All measures were recorded at baseline and during the last 10s of maximal RE. Common carotid artery strain, CCA strain time to peak, and CCA strain rate (i.e., variables of arterial wall dynamics) were analyzed using 2D speckle tracking software from circumferential ultrasound images. Transcranial Doppler was used to measure right middle cerebral artery (MCA) blood velocity. Non-invasive arterial blood pressure measurements were obtained using finger photoplethysmography. Older adults had greater reductions in CCA strain time to peak from baseline to maximal RE (345 ± 39 to 242 ± 52ms) than YA (308 ± 35 to 247 ± 42ms; interaction effect, p < 0.01). MCA velocity was similar between YA and OA during maximal RE (p = 0.48), despite a greater arterial pressor response in OA (p < 0.01). These data suggest cerebral blood velocity responds similarly during maximal RE among OA compared to YA, despite subtle age-related differences in the pressor and extracranial vascular response during maximal RE.

The Predictive Value of Carotid Artery Strain and Strain-Rate in Assessing the 3-Year Risk for Stroke and Acute Coronary Syndrome in Patients with Metabolic Syndrome.

The goal of this study is to see if carotid strain and strain rate can predict major cardio-vascular events (MACE) in people who have metabolic syndrome (MS) over a 3-year period of time. In this prospective observational research, we enrolled 220 adult MS patients (60.7 7.5 years old, 53% male). Two-dimensional common carotid carotid artery (CCA) speckle-tracking ultrasound was used to determine the peak circumferential strain (CS) and the peak circumferential strain rate (CSR). Clinical outcomes were assessed throughout a three-year follow-up period. After a 3-year follow-up period follow-up, 14 (7%) experienced MACE: Eight (4%) suffered an atherothrombotic ischemic stroke, four (2%) had acute coronary syndrome, and two (1%) were hospitalized for heart failure. Univariate regression analysis of the clinical and echocardiographic features of the MS patients found that age, systemic hypertension, diabetes mellitus, and the CCA circumferential strain and strain rate were significantly associated with the risk of MACE. Multivariate logistic regression identified two independent predictors of MACE in patients with MS, namely the CCA-related CS (%) and CSR (1/s), p 0.01. The Receiver operating characteristic (ROC) curve analyses of these independent predictors of MACE indicated appropriate sensitivities and specificities. CS (AUC = 0.806, sensitivity = 82.6%, specificity = 79.2%, p 0.0001) and CSR (AUC = 0.779, sensitivity = 82.6%, specificity = 72.4%, p 0.0001) with cut-off values of 2.9% for carotid CS and 0.35 for carotid CSR. Using these cut-off values, we obtained Kaplan-Meier survival curves, and these showed that MACE, ischemic stroke, and ACS-free survival was significantly lower among the MS patients with lower carotid CS and CSR (p 0.0001). Carotid CS and CSR were independent predictors of major cardio- and cerebro-vascular events in prospectively monitored MS patients without established cardiovascular disease. Carotid deformation could be valuable as an early prognostic indicator for the cardiovascular risk in this population group.

Exploring Further Utilization of Biomechanical Characterization of the Vascular Systemvia Ultrasonography

<h3>Objectives</h3> Stress and strain measurements have been used in clinical settings to predict and describe functions of the human body. However, the role of this modality in the analysis of the vascular system, for both pathologies and physiology, has not been heavily studied. Yet, stress and strain measurements may potentially be a more sensitive modality to evaluate the vascular system. In this abstract, we highlight the concept of utilizing wall biomechanical for enhanced characterization of targeted vascular physiology and pathology. <h3>Methods</h3> This abstract highlights three studies approved by the Institutional Review Board. Various components of the vascular system were analyzed. These included pathological (aneurysmal aorta vs non-aneurysmal aorta), reaction of normal physiology (carotid artery strain pre-and post-exercise) and change in physiology to stress (concomitant carotid and left ventricular strain pre- and post-major surgical intervention). Longitudinal and circumferential strain on the vessel wall was obtained by using two-dimension (2D) speckle tracking ultrasonography. All analysis was electrocardiogram (ECG)-gated as well. Strain patterns for each region of the targeted components of the vascular system were analyzed. <h3>Results</h3> For normal responses to the physiology of the carotid following exercise, there was a marked increase in the percent change of strain in response to small change in the conventional hemodynamic measurements. Consistency strain curves obtained at baseline compared to variable dispersion of strain curves obtained immediately following exercise was noted and had higher sensitivity in detecting changes to physiology compared to conventional methods (Figure 1Figure 1Biomechanical analysis of the carotid artery before exercise (A, C) and after exercise(B, D).Figure 1, Table 1Table 1Volunteer demographics, conventional hemodynamic and strain measurements.Table 1Image, table 1). Additionally, there were consistent strain patterns noted of the carotid and left ventricle at the various time points pre- and post- stress following major surgery (Figure 2Figure 2Biomechanical analysis of the left ventricle pre-operatively (A), immediate post- operatively (B), immediately after extubation (C), and at least 6 hours post-extubation (D).Figure 2). Similarly, consistent strain patterns were noted in aneurysmal aorta segments compared to non- aneurysmal segments (Figure 3Figure 3Biomechanical analysis of aneurysmal (A) vs non-aneurysmal (B) aorta with circumferential strain curve patterns.Figure 3).Table 1<b>Table 1</b> Volunteer demographics, conventional hemodynamic and strain measurements.Table 1Image, table 1 <h3>Conclusion</h3> The concept of utilizing 2D speckle tracking ultrasonography to characterize the wall biomechanics within vascular system (aorta, carotid artery, and left ventricle) may be a feasible new modality for evaluating pathology, normal physiology, and the impact of surgical stress on the vascular system. Consistent patterns of stress and strain curves, which were more sensitive in change following pathological/physiological stress compared to conventional measures, were noted in each setting. Future research evaluating the specific strain patterns and their clinical implications is warranted.

Impact of Applying a Skin Compression With the Ultrasound Probe on Carotid Artery Strain Elastography

To study the impact of varying the external compression exerted by the ultrasound probe when performing a carotid strain elastography exam. Nine healthy volunteers (mean age 43 years ±13 years; 6 men) underwent a vascular ultrasound elastography exam using a custom made sound feedback handle embedding the probe, and allowing the sonographer to adjust the applied compression. A clinical standard practice (SP) force was first recorded, and then predetermined compression (PDC) forces were applied, ranging from 0 to 5 N for the left common carotid artery (CCA) or 2-12 N for the left internal carotid artery (ICA). Six carotid elastography features, namely maximum and cumulated axial strains, maximum and cumulated shear strains, cumulated axial translation, and cumulated lateral translation were assessed with noninvasive vascular elastography (NIVE) on near and far walls of carotids. The carotid intima media thickness (IMT) and diameter were also measured. All elastography features on the near wall of both CCA and ICA decreased statistically significantly as the PDC force increased; this association was also observed for half of the features on the far wall. Three NIVE features at the lowest PDC force (out of 72 that were tested) were statistically significantly different than values at the SP force. Overall, NIVE showed some variance to probe compression with linear regression slopes revealing changes of 10.1%-45.6% in magnitude over the whole compression range on both walls. The maximum IMT for the ICA near wall, and carotid lumen diameters of both CCA and ICA were statistically significantly associated with PDC forces; these features underwent a decrease of 10.2%, 36.2%, and 17.6%, respectively, over the whole range of PDC force increase. Other IMT measurements were not statistically significantly associated with applied PDC forces. These results suggest the need of technical guidelines for carotid strain elastography. Using the lowest probe compression while allowing a good B-mode image quality is recommended to improve the robustness of NIVE measurements.

Subclinical cardiovascular dysfunction in children and adolescents with asthma

Background There is close association between asthma and cardiovascular functions as both diseases share common inflammatory pathways. The current study was aimed at investigating the risk factors, associated with endothelial and cardiac functions in children with newly-diagnosed mild-persistent asthma. Methods A total of 33 steroid-naive asthmatic children [median(interquartile-range); 9.1 years(7.8-13.5)] and 16 healthy controls [11.5 years(9.9-13.6)] were included. Their demographic, clinical and laboratory findings were recorded. Carotid Artery intima-media thickness (CIMT), stiffness, distensibility and strain were measured as atheroclerosis markers. Conventional and tissue Doppler imaging was performed to evaluate ventricular function. Results The patients with asthma had higher CIMT and stiffness and lower strain and distensibility compared to controls (p < 0.001 for all). There was a significant correlation between the duration of asthmatic symptoms and subclinical-atherosclerosis as well as peripheral eosinophil count (p < 0.001, p < 0.05). The patients had lower tricuspid-annular-plane-systolic-excursion (TAPSE), ejection time, and higher isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), and left ventricle myocardial performance index (LVMPI) than the control subjects (p < 0.001 for all). A positive correlation was also observed between the duration of asthmatic-symptoms and cardiac-function parameters. Conclusion Children with mild persistent asthma had subclinical atherosclerosis and ventricular dysfunction even in the early stage of disease. Symptom duration was closely associated with both subclinical atherosclerosis and ventricular dysfunction. Myocardial performance index was abnormal in the asthmatic children when assessed by tissue Doppler Imaging even though they had normal ejection fraction in conventional echocardiography. Future prospective studies with larger sample sizes are needed to confirm these findings and to assess the possible protective effect of ICSs in the prevention of subclinical atherosclerosis.

The influence of habitual endurance exercise on carotid artery strain and strain rate in young and middle-aged men.

What is the central question of this study? Carotid artery peak circumferential strain (PCS) and strain rate attenuate with age, but appear to be modulated by cardiorespiratory fitness status in young males. However, the relationship between habitual endurance exercise (running) and these parameters has not been studied in young and middle-aged men. What is the main finding and its importance? Young and middle-aged runners exhibited elevatedPCSand systolic strain rate (S-SR) compared with non-runners, but habitual running did not influence diastolic strain rate (D-SR). Habitual exercise is associated with comparable improvements in carotid strain parameters in young and middle-aged men, but the age-related decline in PCS and S-SR might be more amenable to habitual endurance exercise than D-SR. Central arterial stiffness is an independent predictor of cardiovascular risk that can be modified by exercise training. However, conventional local measures of carotid artery stiffness display conflicting responses to habitual endurance exercise in young and older adults. Two-dimensional (2D)-Strain imaging of the common carotid artery (CCA) quantifies circumferential deformation (strain) of the arterial wall across the cardiac cycle, which is more sensitive at detecting age-related alterations in CCA stiffness than conventional methods. Therefore, the study was designed to examine the relationship between habitual endurance exercise (running) and CCA 2D-Strain parameters in young and middle-aged men. Short-axis ultrasound images of the CCA wereobtained from 13young non-runners [23years of age (95% confidence interval: 21, 26years of age)],19young runners [24(22, 26)years of age],13middle-aged non-runners [54(52, 56)years of age] and19middle-aged runners [56(54, 58)years of age].Images were analysed for peak circumferential strain (PCS; magnitude of deformation) and systolic and diastolic strain rates (S-SR and D-SR; deformation velocity), and group differences were examined via two-way ANOVA. PCS, S-SR and D-SR were attenuated in middle-aged men compared with young men (all P≤0.001). PCS and S-SR were elevated in young and middle-aged runners when compared with non-runners (P=0.002 and P=0.009, respectively), but no age×training status interaction was observed. In contrast, there was no influence of habitual running on D-SR. Habitual exercise is associated with comparable improvements in CCA 2D-Strain parameters in young and middle-aged men, but the age-related decline in PCS and S-SR might be more amenable to habitual endurance exercise than D-SR.

A Potentially Novel Platform: Utilization of Biomechanical Characterization of the Vascular System

Stress and strain measurements have been used in clinical settings to predict and describe functions of the human body. However, the role of this modality in the analysis of the vascular system, for both pathologies and physiology, has not been heavily studied. Yet, stress and strain measurements may potentially be a more sensitive modality to evaluate the vascular system. In this abstract, we highlight the concept of using wall biomechanical for enhanced characterization of targeted vascular physiology and pathology. This review discusses three studies approved by the institutional review board. Various components of the vascular system were analyzed. These included pathologic (aneurysmal aorta vs nonaneurysmal aorta), reaction of normal physiology (carotid artery strain before and after exercise) and change in physiology to stress (concomitant carotid and left ventricular strain before and after a major surgical intervention). Longitudinal and circumferential strain on the vessel wall was obtained by using two-dimensional speckle tracking ultrasound examinations. All analysis was electrocardiogram gated as well. Strain patterns for each region of the targeted components of the vascular system were analyzed. Consistent strain patterns were noted in aneurysmal aorta segments compared to nonaneurysmal segments (Fig 1). Similarity was noted across regional strain curves and data obtained from the nonaneurysmal portion of the aorta compared with dissimilar variable strain curves in the aneurysmal aorta (Fig 1). For normal responses to the physiology of the carotid following exercise, there was a marked increase in the percent change of strain in response to small change in the conventional hemodynamic measurements. Consistency strain curves obtained at baseline compared to variable dispersion of strain curves obtained immediately following exercise was noted and had higher sensitivity in detecting changes to physiology compared to conventional methods (Fig 2A). Additionally, there were consistent strain patterns noted of the carotid and left ventricle at the various time points prestress and post-stress following major surgery (Fig 2B). The concept of using two-dimensional speckle tracking ultrasonography to characterize the wall biomechanics within vascular system (aorta, carotid artery, and left ventricle) may be a feasible new modality for evaluating pathology, normal physiology, and the impact of surgical stress on the vascular system. Consistent patterns of stress and strain curves, which were more sensitive in change following pathologic/physiologic stress compared to conventional measures, were noted in each setting. Future research evaluating the specific strain patterns and their clinical implications is warranted.Fig 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Increased carotid artery wall stiffness and plaque prevalence in HIV infected patients measured with ultrasound elastography.

Assess carotid artery strain and motion in people living with HIV as markers of premature aging using ultrasound noninvasive vascular elastography (NIVE). Seventy-four HIV-infected and 75 age-matched control subjects were recruited from a prospective, controlled cohort study from October 2015 to October 2017 (mean age 56years±8years; 128 men). NIVE applied to longitudinal ultrasound images of common and internal carotid arteries quantified the cumulated axial strain, cumulated shear strain, cumulated axial translation, and cumulated lateral translations. The presence of plaque was also assessed. An association between elastography biomarkers and HIV status was evaluated with Mann-Whitney tests and multivariable linear regression models. A higher occurrence of carotid artery plaques was found in HIV-infected individuals (p= 0.011). Lower cumulated lateral translations were found in HIV-infected subjects on both common and internal carotid arteries (p=0.037 and p=0.026, respectively). These observations remained significant when considering multivariable models including common cardiovascular risk factors and clinical characteristics (p<0.05). Lower cumulated axial strains were also observed in internal carotid arteries when considering both multivariable models (p<0.05). Lower translation and strain of the carotid artery wall in HIV-infected individuals indicates increased vessel wall stiffness. These new imaging biomarkers could be used to characterize premature atherosclerosis development. • Noninvasive vascular elastography (NIVE) based on ultrasound imaging quantifies translations and strains of carotid arteries. • Lower translation and strain of the carotid artery wall found in HIV-infected individuals indicate premature arterial stiffening, compared with age-matched controls. • Carotid artery plaques were more prevalent in HIV-infected individuals than in control subjects.

İnvestigation of endothelial dysfunction in children with acute rheumatic fever.

Background:Acute rheumatic fever (ARF) is an important cause of valvular heart disease in children. Endothelial dysfunction plays an important role in the pathogenesis of valvular heart diseases. The role of endothelial dysfunction in valvular heart diseases due to ARF is not exactly known. In ARF, autoimmune injury, inflammation, oxidative stress, and impairment of nitric oxide in valvular endothelium may be the causes of endothelial dysfunction. The purpose of this study is to evaluate endothelial dysfunction and arterial stiffness in children with ARF.Materials and Methods:Thirty-six patients diagnosed with ARF (the mean age was 11.80 ± 2.82 years) and 36 volunteered individuals with similar age, sex, and body mass index were included in the study. The study groups were compared in terms of M-mode echocardiography parameters, carotid arterial strain (CAS), beta-stiffness index (βSI), and flow-mediated dilation (FMD).Results:In patients with ARF, there was a decrease in FMD% (10.36 ± 7.26 and 12.76 ± 4.59; P < 0.001) compared to the control group. In addition, CAS (0.16 ± 0.06 and 0.18 ± 0.08; P = 0.44) and βSI (3.65 ± 1.61 and 3.57 ± 2.38; P = 0.24) were similar in the patient and the control groups. Furthermore, no correlation was detected between decreased FMD value and mitral regurgitation (r = −0.07; P = 0.66), aortic regurgitation (r = −0.04; P = 0.78), CAS (r = −0.08; P = 0.61), and βSİ (r = −0.20; P = 0.22).Conclusion:In our study, a decrease in FMD value, which is a marker of endothelial dysfunction, was found in children with rheumatic carditis.

Cardiac structure and function in youth with type 2 diabetes in the iCARE cohort study: Cross-sectional associations with prenatal exposure to diabetes and metabolomic profiles.

This study aimed to determine the degree of left ventricular (LV) dysfunction and its determinants in adolescents with type 2 diabetes (T2D). We hypothesized that adolescents with T2D would display impaired LV diastolic function and that these cardiovascular complications would be exacerbated in youth exposed to maternal diabetes in utero. Left ventricular structure and function, carotid artery intima media thickness and strain, and serum metabolomic profiles were compared between adolescents with T2D (n = 121) and controls (n = 34). Sub-group analyses examined the role of exposure to maternal diabetes as a determinant of LV or carotid artery structure and function among adolescents with T2D. Adolescents with T2D were 15.1 ± 2.5 years old, (65% female, 99% Indigenous), had lived with diabetes for 2.7 ± 2.2 years, had suboptimal glycemic control (HbA1c = 9.4 ± 2.6%) and 58% (n = 69) were exposed to diabetes in utero. Compared to controls, adolescents with T2D displayed lower LV diastolic filling (early diastole/atrial filling rate ratio [E/A] = 1.9 ± 0.6 vs 2.2 ± 0.6, P = 0.012), lower LV relaxation and carotid strain (0.12 ± 0.05 vs 0.17 ± 0.05, P = .03) and elevated levels of leucine, isoleucine and valine. Among adolescents with T2D, exposure to diabetes in utero was not associated with differences in LV diastolic filling, LV relaxation, carotid strain or branched chain amino acids. Adolescents with T2D display LV diastolic dysfunction, carotid artery stiffness, and elevated levels of select branch chain amino acids; differences were not associated with exposure to maternal diabetes in utero.

Usefulness of Carotid Arterial Strain Values for Evaluating the Arteriosclerosis.

Aim: We investigated the clinical usefulness of carotid arterial strain and the strain rate for evaluating the progression of arteriosclerosis measured using a two-dimensional speckle-tracking method in carotid ultrasonography.Methods: We enrolled 259 participants (age: 64 ± 12 years; men: 149; women: 110) in this retrospective analysis. The circumferential strain and the strain rate were measured in bilateral common carotid arteries, and the lowest values were used for the analyses. To assess the characteristics of strain and the strain rate, we investigated the associations between the strain values and gender, age, body mass index (BMI), blood pressure (BP), and the presence of hypertension, diabetes mellitus, and hyperlipidemia. We also examined the explanatory factors for the strain values using clinical parameters along with the intima-media thickness (IMT), the ankle brachial index (ABI), and the cardio-ankle vascular index (CAVI) as possible candidates. Finally, we investigated whether the strain values might be an independent predictor for vascular diseases using multivariate logistic regression analyses.Results: The carotid circumferential strain and the strain rate were significantly correlated with age, IMT, and the CAVI, but not with the BMI, BP, or ABI. Strain and the strain rates were lower in participants with hypertension or cerebrovascular disease and were selected as significant predictive factors for the presence of cerebrovascular diseases, together with diabetes and the CAVI.Conclusions: Strain and the strain rate of carotid arteries, which could represent local arterial stiffness, might be associated with atherosclerosis and could possibly be used to predict cerebrovascular disease.

Speckle tracking carotid artery circumferential strain is a marker of arterial sclerosis but not coronary atherosis.

Circumferential speckle tracking carotid artery strain is a novel method of quantifying vessel wall stiffness. We hypothesized that carotid wall stiffness would be associated with carotid intimal medial thickening (a medial process associated with risk factors), but not coronary artery disease (an intimal process). Bilateral carotid artery ultrasound was conducted on outpatients who had previously undergone elective coronary angiography. Mean carotid artery far wall circumferential strain (FWCS) was assessed for correlations with coronary angiographic stenosis, cardiac risk factors, carotid intima-media thickness (CIMT), and carotid plaque. One hundred and sixty five (165) patients were studied. No significant association was found between the presence of coronary artery disease on angiography and mean FWCS. FWCS was higher in current tobacco smokers. In addition, carotid strain was found to decrease with increased age (r = -0.33, P < 0.001). When adjusted for pulse pressure (PP), FWCS/PP was negatively correlated with mean CIMT (r = -0.29, P = 0.002) and bulb maximum plaque height (r = -0.27, P = 0.004). Hypertension and diabetes were associated with decreased FWCS/PP (increased wall stiffness). While no clear relationship between carotid strain and coronary artery disease was observed, increased CIMT, carotid plaque, and cardiac risk factors were associated with decreased carotid strain. Further work is required to explore the relationship between carotid strain and cardiovascular events.