Common Carotid Intima-media Thickness Measurements Research Articles

Ultrasound Intima-Media Complex (IMC) Segmentation Using Deep Learning Models

Common carotid intima-media thickness (CIMT) is a common measure of atherosclerosis, often assessed through carotid ultrasound images. However, the use of deep learning methods for medical image analysis, segmentation and CIMT measurement in these images has not been extensively explored. This study aims to evaluate the performance of four recent deep learning models, including a convolutional neural network (CNN), a self-organizing operational neural network (self-ONN), a transformer-based network and a pixel difference convolution-based network, in segmenting the intima-media complex (IMC) using the CUBS dataset, which includes ultrasound images acquired from both sides of the neck of 1088 participants. The results show that the self-ONN model outperforms the conventional CNN-based model, while the pixel difference- and transformer-based models achieve the best segmentation performance.

Carotid Ultrasound Boundary Study (CUBS): An Open Multicenter Analysis of Computerized Intima–Media Thickness Measurement Systems and Their Clinical Impact

Common carotid intima–media thickness (CIMT) is a commonly used marker for atherosclerosis and is often computed in carotid ultrasound images. An analysis of different computerized techniques for CIMT measurement and their clinical impacts on the same patient data set is lacking. Here we compared and assessed five computerized CIMT algorithms against three expert analysts’ manual measurements on a data set of 1088 patients from two centers. Inter- and intra-observer variability was assessed, and the computerized CIMT values were compared with those manually obtained. The CIMT measurements were used to assess the correlation with clinical parameters, cardiovascular event prediction through a generalized linear model and the Kaplan–Meier hazard ratio. CIMT measurements obtained with a skilled analyst's segmentation and the computerized segmentation were comparable in statistical analyses, suggesting they can be used interchangeably for CIMT quantification and clinical outcome investigation. To facilitate future studies, the entire data set used is made publicly available for the community at http://dx.doi.org/10.17632/fpv535fss7.1.

Discovery of biomarkers for the presence and progression of left ventricular diastolic dysfunction and HEart faiLure with Preserved ejection Fraction in patients at risk for cardiovascular disease: rationale and design of the HELPFul case-cohort study in a Dutch cardiology outpatient clinic

IntroductionLeft ventricular diastolic dysfunction (LVDD) is a common condition in both sexes that may deteriorate into heart failure (HF) with preserved ejection fraction (pEF), although this seems to happen more...

Childhood infections and common carotid intima media thickness in adolescence.

Atherosclerotic changes can be measured as changes in common carotid intima media thickness (CIMT). It is hypothesised that repeated infection-associated inflammatory responses in childhood contribute to the atherosclerotic process. We set out to determine whether the frequency of infectious diseases in childhood is associated with CIMT in adolescence. The study is part of the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) population-based birth cohort. At age 16 years, common CIMT was measured. We collected general practitioner (GP) diagnosed infections and prescribed antibiotics. Parent-reported infections were retrieved from annual questionnaires. Linear regression analysis assessed the association between number of infections during the first 4 years of life and common CIMT. Common CIMT measurement, GP and questionnaire data were available for 221 participants. No association was observed between the infection measures and CIMT. In a subgroup analysis, significant positive associations with CIMT were observed in participants with low parental education for 2-3 or ⩾7 GP diagnosed infections (+26.4 µm, 95% CI 0.4-52.4 and +26.8 µm, 95% CI 3.6-49.9, respectively) and ⩾3 antibiotic prescriptions (+35.5 µm, 95%CI 15.8-55.3). Overall, early childhood infections were not associated with common CIMT in adolescence. However, a higher number of childhood infections might contribute to the inflammatory process of atherosclerosis in subgroups with low education, this needs to be confirmed in future studies.

Study of the Prevalence of Microalbuminuria in Patients of Essential Hypertension and its Correlation with Left Ventricular Hypertrophy and Carotid Artery Intima-media Thickness

Background: Limited evidence is available among Indian patients regarding significance of microalbuminuria (MA) in context of hypertension and future cardiovascular morbidity. Therefore, the current study was undertaken to determine the prevalence of MA in hypertensive patients and to examine its correlation with severity of hypertension, left ventricular hypertrophy (LVH), and common carotid intima-media thickness (CCIMT). Material and Methods: Fifty treatment-naive hypertensive patients (16–80 years of age) were prospectively enrolled. All patients underwent basic metabolic profile, urine evaluation, echocardiography, and measurement of CCIMT, and the data were evaluated. Results: MA (defined as urinary albumin excretion in the range of 30–300 mg/24 h) was present in 44% of patients with newly detected essential hypertension. A significant number of patients with MA had abnormally high mean left ventricular mass index as compared to those without MA. In addition, a positive correlation was also observed between MA and LVH. Furthermore, mean CCIMT was found to be higher in patients with MA (P

Carotid and Femoral Arterial Wall Distensibility During Long-Duration Spaceflight.

This study aimed to assess changes in common carotid (CA) and superficial femoral (FA) arterial stiffness during long-duration spaceflight. Ultrasound imaging was used to investigate the CA and FA of 10 astronauts preflight (PRE), on flight day 15 (FD15), after 4-5 mo (FD4-5m), and 4 d after return to Earth (R+4). Arterial wall properties were assessed through the calculation of strain, stiffness (β), pressure-strain elastic modulus (Ep), and distensibility (DI). Stiffness indices were assessed for potential correlations to measurements of intima-media thickness (IMT). Significant effects of spaceflight were found for all CA stiffness indices, indicating an increase in arterial stiffness. CA strain was reduced by 34 ± 31% on FD15 and 50 ± 16% on FD4-5m and remained reduced by 42 ± 14% on R+4 with respect to PRE values. On FD4-5m, with respect to PRE values, DI was reduced by 46 ± 25% and β and Ep were increased by 124 ± 95% and 118 ± 92%, respectively. FA arterial stiffness indices appeared to show similar changes; however, a main effect of spaceflight was only found for strain. Correlation analysis showed weak but significant relationships between measurements of CA IMT and arterial stiffness indices, but no relationships were found for FA measurements. The observed change in CA and FA stiffness indices suggest that spaceflight results in an increase in arterial stiffness. That these changes were not strongly related to measurements of IMT suggests the possibility of different mechanisms contributing to the observed results.Arbeille P, Provost R, Zuj K. Carotid and femoral arterial wall distensibility during long-duration spaceflight. Aerosp Med Hum Perform. 2017; 88(10):924-930.

Abstract P322: Soda Consumption is Associated With Carotid Intima-Media Thickness Among Middle-Aged Mexican Women

Introduction: Soda intake is associated with cardiovascular disease. Other sweetened drinks often considered healthy alternatives to sodas could have a similar impact on cardiovascular risk. Hypothesis: Sugar-sweetened beverages commonly consumed by Hispanics have a negative influence on cardiovascular risk. Methods: We evaluated the cross-sectional relationship of sweetened beverages and common carotid intima-media thickness (CIMT) in 1,054 disease-free women without diabetes, high cholesterol, history of stroke and/or myocardial infarction, from the Mexican Teachers’ Cohort. Beverage intake was estimated from a validated food-frequency questionnaire in 2008 and 4 years later, CIMT measurements were performed by neurologists. We defined subclinical atherosclerosis as CIMT ≥0.8mm or presence of plaque and beverage intake was categorized in quartiles of servings/day. Results: Mean (±SD) soda intake was 0.5 ± 0.7 servings/day among 45.2 ± 4.7 year old women and atherosclerosis prevalence was 8.7%. After adjusting for age, smoking, secondhand smoke, physical activity, oral contraception, menopausal status, SES, and diet, % change of CIMT per 1 serving/day of soda was 1.3 (95% CI 0.2-2.3). Comparing extreme quartiles of soda intake, we observed a 3.5% (95% CI 1.1-5.8; p-trend=0.003) increase in CIMT (Figure). Intake of artificially-sweetened soda, fruit infused water, and juice was not associated to CIMT. None of the beverages were associated to subclinical atherosclerosis. Conclusions: In this cross-sectional study, soda intake was associated to increased CIMT while artificially-sweetened soda, fruit water, or juice intakes were not. Our results support prior results on the adverse consequences of soda intake in cardiovascular health. Keywords: sugar-sweetened beverages, cardiovascular risk, intima media thickness, cross-sectional

Common carotid intima-media thickness relates to cardiovascular events in adults aged

Although atherosclerosis starts in early life, evidence on risk factors and atherosclerosis in individuals aged <45 years is scarce. Therefore, we studied the relationship between risk factors, common carotid intima-media thickness (CIMT), and first-time cardiovascular events in adults aged <45 years. Our study population consisted of 3067 adults aged <45 years free from symptomatic cardiovascular disease at baseline, derived from 6 cohorts that are part of the USE-IMT initiative, an individual participant data meta-analysis of general-population-based cohort studies evaluating CIMT measurements. Information on risk factors, CIMT measurements, and follow-up of the combined end point (first-time myocardial infarction or stroke) was obtained. We assessed the relationship between risk factors and CIMT and the relationship between CIMT and first-time myocardial infarction or stroke using a multivariable linear mixed-effects model and a Cox proportional-hazards model, respectively. During a follow-up of 16.3 years, 55 first-time myocardial infarctions or strokes occurred. Median CIMT was 0.63 mm. Of the risk factors under study, age, sex, diastolic blood pressure, body mass index, total cholesterol, and high-density lipoprotein cholesterol related to CIMT. Furthermore, CIMT related to first-time myocardial infarction or stroke with a hazard ratio of 1.40 per SD increase in CIMT, independent of risk factors (95% confidence interval, 1.11-1.76). CIMT may be a valuable marker for cardiovascular risk in adults aged <45 years who are not yet eligible for standard cardiovascular risk screening. This is especially relevant in those with an increased, unfavorable risk factor burden.

Common carotid intima-media thickness does not add to Framingham risk score in individuals with diabetes mellitus: the USE-IMT initiative

The aim of this work was to investigate whether measurement of the mean common carotid intima-media thickness (CIMT) improves cardiovascular risk prediction in individuals with diabetes. We performed a subanalysis among 4,220 individuals with diabetes in a large ongoing individual participant data meta-analysis involving 56,194 subjects from 17 population-based cohorts worldwide. We first refitted the risk factors of the Framingham heart risk score on the individuals without previous cardiovascular disease (baseline model) and then expanded this model with the mean common CIMT (CIMT model). The absolute 10year risk for developing a myocardial infarction or stroke was estimated from both models. In individuals with diabetes we compared discrimination and calibration of the two models. Reclassification of individuals with diabetes was based on allocation to another cardiovascular risk category when mean common CIMT was added. During a median follow-up of 8.7years, 684 first-time cardiovascular events occurred among the population with diabetes. The C statistic was 0.67 for the Framingham model and 0.68 for the CIMT model. The absolute 10year risk for developing a myocardial infarction or stroke was 16% in both models. There was no net reclassification improvement with the addition of mean common CIMT (1.7%; 95% CI -1.8, 3.8). There were no differences in the results between men and women. There is no improvement in risk prediction in individuals with diabetes when measurement of the mean common CIMT is added to the Framingham risk score. Therefore, this measurement is not recommended for improving individual cardiovascular risk stratification in individuals with diabetes.

Tratamento pós-menopausa reduz a atividade da catalase e atenua o risco cardiovascular

Menopause can lead to alterations in women's health, with changes in the oxidative status of postmenopausal women in whom information regarding the influence of hormone therapy (HT) on antioxidant enzyme activities is limited. To evaluate the influence of HT on catalase activity; concentrations of lipids and lipoprotein, cholesteryl ester transfer protein, thiobarbituric acid-reactive substances, nitrates, high-sensitivity C-reactive protein and carotid thickness in postmenopausal women. Ninety-four consecutive women were allocated to one of four groups, without HT and with HT. The latter group was subdivided into women using estrogen and those using estrogen plus progestogen therapy. Plasma biochemical parameters and common carotid intima-media thickness measurements were performed. HT antagonized the decrease in catalase activity after menopause, but had no effect on the levels of cholesteryl ester transfer protein, thiobarbituric acid-reactive substances, lipid peroxide, nitrate, high-sensitivity C-reactive protein, or on the common carotid intima-media thickness. Multivariate analysis showed that estrogen-based HT attenuated the relationship between cardiovascular risk factors and the intima-media thickness of the common carotid. This study indicates that HT in postmenopausal women produces beneficial antioxidant and anti-atherosclerotic effects by ameliorating the plasma lipid and lipoprotein profiles, increasing plasma catalase activity and attenuating the association between cardiovascular risk factors and early atherosclerosis.

Common Carotid Intima-Media Thickness Measurements in Cardiovascular Risk Prediction

The evidence that measurement of the common carotid intima-media thickness (CIMT) improves the risk scores in prediction of the absolute risk of cardiovascular events is inconsistent. To determine whether common CIMT has added value in 10-year risk prediction of first-time myocardial infarctions or strokes, above that of the Framingham Risk Score. Relevant studies were identified through literature searches of databases (PubMed from 1950 to June 2012 and EMBASE from 1980 to June 2012) and expert opinion. Studies were included if participants were drawn from the general population, common CIMT was measured at baseline, and individuals were followed up for first-time myocardial infarction or stroke. Individual data were combined into 1 data set and an individual participant data meta-analysis was performed on individuals without existing cardiovascular disease. We included 14 population-based cohorts contributing data for 45,828 individuals. During a median follow-up of 11 years, 4007 first-time myocardial infarctions or strokes occurred. We first refitted the risk factors of the Framingham Risk Score and then extended the model with common CIMT measurements to estimate the absolute 10-year risks to develop a first-time myocardial infarction or stroke in both models. The C statistic of both models was similar (0.757; 95% CI, 0.749-0.764; and 0.759; 95% CI, 0.752-0.766). The net reclassification improvement with the addition of common CIMT was small (0.8%; 95% CI, 0.1%-1.6%). In those at intermediate risk, the net reclassification improvement was 3.6% in all individuals (95% CI, 2.7%-4.6%) and no differences between men and women. The addition of common CIMT measurements to the Framingham Risk Score was associated with small improvement in 10-year risk prediction of first-time myocardial infarction or stroke, but this improvement is unlikely to be of clinical importance.

Manual or semi‐automated edge detection of the maximal far wall common carotid intima–media thickness: a direct comparison

Automated edge detection is thought to be superior to manual edge detection in quantification of the far wall common carotid intima-media thickness (CIMT), yet published evidence making a direct comparison is not available. Data were used from the METEOR study, a randomized placebo-controlled trial among 984 individuals showing that rosuvastatin attenuated the rate of change of 2 year change in CIMT among low-risk individuals with subclinical atherosclerosis. For this post hoc analysis, CIMT images of the far wall of the common carotid artery were evaluated using manual and semi-automated edge detection and reproducibility, relation to cardiovascular risk factors, rates of change over time and effects of lipid-lowering therapy were assessed. Reproducibility was high for both reading methods. Direction, magnitude and statistical significance of risk factor relations were similar across methods. Rate of change in CIMT in participants assigned to placebo was 0.0066 mm per year (SE: 0.0027) for manually and 0.0072 mm per year (SE: 0.0029) for semi-automatically read images. The effect of lipid-lowering therapy on CIMT changes was -0.0103 mm per year (SE: 0.0032) for manual reading and -0.0111 mm per year (SE: 0.0034) for semi-automated reading. Manual and semi-automated readings of the maximal far wall of the common CIMT images both result in high reproducibility, show similar risk factor relations, rates of change and treatment effects. Hence, choices between semi-automated and manual reading software for CIMT studies likely should be based on logistical and cost considerations rather than differences in expected data quality when the choice is made to use far wall common CIMT measurements.

Inter‐Reader Differences in Common Carotid Artery Intima‐Media Thickness

Far wall common carotid artery intima-media thickness, a surrogate measure of atherosclerosis, requires the tracing of two carotid wall interfaces on ultrasound images: the lumen-intima and media-adventitia. Vascular age is derived from intima-media thickness measurements. We studied how tracing the wall interfaces affects intima-media thickness measurements and estimates of vascular age. Five readers made far-wall common carotid intima-media thickness measurements on 26 carotid artery images. Each reader traced lines at the lumen-intima and media-adventitia interfaces. An observer, blinded to reader identity and intima-media thickness values, reviewed the images and estimated the relative location of these lines compared to his judgment of the interface location: +1 for 1 pixel above the interface, 0 at the interface, and -1 if below. The significance of differences was evaluated by analysis of variance. Mean intima-media thickness measurements ranged between 0.57 and 0.78 mm and showed significant differences between readers (P < .009). Differences in carotid intima-media thickness measurements made by the readers were significantly associated with the location of the media-adventitia interfaces (P < .0001) but not the lumen-intima interfaces (P = .07). The intima-media thickness differences corresponded to mean differences in estimated vascular age ranging from 14 to 21 years. Inter-reader differences in common carotid intima-media thickness measurements are mostly seen for the media-adventitia wall interface and are detectable by an experienced observer. These inter-reader differences affect the use of intima-media thickness measurements for cardiovascular risk evaluation, can cause substantial errors in vascular age estimates, and might be correctable by performing replicate readings of standard image sets.

The Relation between the Color M‐Mode Propagation Velocity of the Descending Aorta and Coronary and Carotid Atherosclerosis and Flow‐Mediated Dilatation

To improve clinical outcomes, noninvasive imaging modalities have been proposed to measure and monitor atherosclerosis. Common carotid intima-media thickness (CIMT) and brachial artery flow-mediated dilatation (FMD) have correlated with coronary atherosclerosis. Recently, the color M-mode-derived propagation velocity of descending thoracic aorta (AVP) was shown to be associated with coronary artery disease (CAD). CIMT, FMD, and AVP were measured in 92 patients with CAD and 70 patients having normal coronary arteries (NCA) detected by coronary angiography. Patients with acute myocardial infarction, renal failure or hepatic failure, aneurysm of aorta, severe valvular heart disease, left ventricular ejection fraction <40%, atrial fibrillation, frequent premature beats, left bundle branch block, and inadequate echocardiographic image quality were excluded. Compared to patients with normal coronary arteries, patients having CAD had significantly lower AVP (29.9 +/- 8.1 vs. 47.5 +/- 16.8 cm/sec, P < 0.001) and FMD (5.3 +/- 1.9 vs. 11.4 +/- 5.8%, P < 0.001) and higher CIMT (0.94 +/- 0.05 vs. 0.83 +/- 0.14 mm, P < 0.001) measurements. There were significant correlations between AVP and CIMT (r =-0.691, P < 0.001), AVP and FMD (r = 0.514, P < 0.001) and FMD and CIMT (r =-0.530, P < 0.001). The transthoracic echocardiographic determination of the color M-mode propagation velocity of the descending aorta is a simple practical method and correlates well with the presence of carotid and coronary atherosclerosis and brachial endothelial function.

Androgen excess is associated with the increased carotid intima-media thickness observed in young women with polycystic ovary syndrome

We evaluated carotid intima-media thickness (CIMT) as an early marker of atherosclerosis, as well as its main determinants among androgen excess, obesity and insulin resistance, in patients with polycystic ovary syndrome (PCOS). We selected 40 PCOS patients and 20 non-hyperandrogenic women who were similar in terms of age and grade of obesity. Complete clinical, metabolic and hormonal profiles and left common CIMT measurements were obtained. Patients with PCOS presented with increased mean CIMT values when compared with controls (F = 8.575; P = 0.005), and this was independent of obesity. Five PCOS patients but no controls had increased CIMT values. CIMT correlated directly with serum total and free testosterone, androstenedione and dehydroepiandrosterone-sulfate levels and mean 24-h heart rate (HR), and inversely with the insulin sensitivity index (ISI), but no correlation was observed with the body mass index (BMI). Multiple stepwise linear regression models showed that in PCOS patients, the main determinants of CIMT were serum total testosterone or androstenedione concentrations, with no influence of ISI or the mean 24-h HR. Compared with control women, PCOS patients present with an increased CIMT, independent of obesity and related directly to androgen excess; this suggests that hyperandrogenism is associated with atherosclerosis and cardiovascular risk in these women.

Automated Radio-Frequency versus manual B-mode ultrasound common carotid intima-media thickness measurements in routine clinical practice: a direct comparison of risk factor relations and associations with future events

Automated Radio-Frequency versus manual B-mode ultrasound common carotid intima-media thickness measurements in routine clinical practice: a direct comparison of risk factor relations and associations with future events

Effect of a Treatment Strategy Consisting of Pravastatin, Vitamin E, and Homocysteine Lowering on Carotid Intima-Media Thickness, Endothelial Function, and Renal Function in Patients With Mild to Moderate Chronic Kidney Disease

Patients with chronic kidney disease have an increased risk of cardiovascular disease. Oxidative stress has been proposed to play a role in the development of cardiovascular disease among these patients. We conducted a randomized, double-blind trial in 93 patients (Cockcroft-Gault equation: creatinine clearance, 38+/-15 [mean+/-SD] mL/min per 1.73 m2 [0.63+/-0.25 mL/s per m2]) to investigate the effect of a treatment strategy designed primarily to achieve stepwise oxidative stress reduction on common carotid intima-media thickness (CC-IMT), brachial artery flow-mediated dilatation (BA-FMD), albuminuria, and renal function. The treatment group received a regimen of pravastatin to which vitamin E supplementation was added after 6 months and homocysteine-lowering therapy after another 6 months. Blood pressure in both groups was managed according to a standard protocol. The placebo group received matching placebos. Measurement of CC-IMT and BA-FMD was performed at randomization after 6, 12, and 18 months. Patients were followed up for 2 years. Generalized estimating equations were used for analysis. Compared with placebo, active treatment was associated with a decrease in CC-IMT (after 18 months: from 0.68 to 0.63 mm in the treatment group and from 0.65 to 0.71 mm in the placebo group; P<.001), an increase in BA-FMD (after 18 months: from 4.66% to 7.56% in the treatment group and from 6.21% to 4.73% in the placebo group; P<.001), and an attenuated increase in urinary albumin excretion over time (P=.04 for between-group difference after 24 months), but no effect was observed on renal function. In patients with mild to moderate chronic kidney disease, 18 months of a treatment strategy along with well-controlled blood pressure reduced CC-IMT and urinary albumin excretion and increased BA-FMD. clinicaltrials.gov Identifier: NCT00384618.

Evaluating the use of a portable ultrasound machine to quantify intima-media thickness and flow-mediated dilation: Agreement between measurements from two ultrasound machines

Flow-mediated dilation (FMD) and common carotid intima-media thickness (CIMT) are intermediate endpoints for cardiovascular disease. The purpose of this study was to determine whether a portable ultrasound machine was capable of valid measurements of FMD and CIMT compared with a clinic-based machine under similar conditions. Vascular images were taken on 23 apparently healthy young adults with the portable type and clinic type instruments. The analyses revealed a high level of agreement between the two machines for measurements of maximum CIMT (mean difference [MD] = –0.025 mm, limits of agreement [LOA] = –0.080, 0.029 mm), mean CIMT (MD = 0.001 mm, LOA = –0.065, 0.065 mm) and FMD measures of brachial diameter (baseline MD = 0.199 mm, LOA = –0.210, 0.608 mm, maximum MD = 0.218 mm, LOA = –0.162, 0.597 mm). Reasonable agreement was found for %FMD measurements (MD = 0.27%, LOA = –4.91, 5.44%). The within-machine coefficient of variation results for maximum CIMT (5.0%), mean CIMT (4.3%), baseline (6.3%) and maximum (5.4%) brachial diameter and %FMD (30.1%) were comparable with normal within-subject variation. We conclude that the portable ultrasound machine can provide measurements of FMD and CIMT that are highly comparable with measurements obtained from a clinic-based machine under similar clinical conditions. (E-mail: cmagnuss@utas.edu.au)

Common carotid intima-media thickness measurement is not a pertinent predictor for secondary cardiovascular events after coronary bypass surgery. A prospective study

We aimed to assess the utility of common carotid intima-media thickness (CCA-IMT) to predict secondary cardiovascular events after coronary artery bypass grafting (CABG). In primary prevention, carotid-IMT is known as a valuable cardiovascular risk marker, but its interest in secondary prevention has been less studied. We hypothesized that CCA-IMT could be used for peri-operative and long-term risk stratification in candidates for CABG. A total of 609 patients (66.8+/-9.2 years) were prospectively enrolled for preoperative CCA-IMT measurement and follow-up. The primary end-point combined cardiovascular death, non-fatal acute coronary syndromes, stroke, secondary coronary revascularization and peripheral arterial surgery during follow-up. The secondary end-point was the 1-month post-operative death. Univariate and multivariate analysis were performed by usual methods. A subgroup of 150 patients (24.6%) was individualized with a CCA-IMT above 90th percentile (>0.90 mm) or presenting plaques in their CCA. At 1 month, there was no significant difference in the prevalence of elevated CCA-IMT between deceased patients and survivors (16.7 vs. 24.9%, P=ns). During a mean follow-up of 41.8+/-16 months, 121 patients (19.8%) met the primary end-point. High CCA-IMT was predictive (OR=1.67, 95% CI 1.14-2.46, P=0.009) in the univariate analysis. In the multivariate analysis, age (OR=1.03, 95% CI 1.00-1.05, P=0.029) concomitant valvular surgery (OR=2.17, P=0.003) arrhythmia (OR=2.20, P=0.021), and peripheral arterial disease (OR=2.41, P<0.001) were significant independent prognostic factors whereas CCA-IMT failed to remain independently significant. Pre-operative CCA-IMT can provide prognostic information for candidates to CABG. However, clinical data present stronger prognostic values.

Common Carotid Intima-Media Thickness and Risk of Acute Myocardial Infarction

It has been argued that lumen diameter of the common carotid artery should be taken into account in analyses on common carotid intima-media thickness (CIMT) and cardiovascular risk. Yet, no published report has dealt with this issue in detail. In the Rotterdam study baseline ultrasound images of the carotid arteries were made. During follow-up of 8.2 years, 656 new acute myocardial infarctions (AMI) occurred. Regression analysis was used to study myocardial infarction relation to right (or left) common CIMT with various adjustments for right-, or left-sided lumen diameter. Lumen adjustment was made by (1) a simple adjustment in a regression equation; (2) using the CIMT-to-lumen ratio; (3) using arterial mass, calculated as ({pix[(lumen+near wall CIMT+far wall CIMT)/2]2}-[pix(lumen/2)2]). AMI disease risk increased per standard deviation increase in common CIMT (0.177 mm): hazard ratio (HR) 1.28 (95% CI, 1.19 to 1.37). When lumen diameter was taken into account the HR was 1.26 (95% CI, 1.18 to 1.35). The HR for the CIMT-to-lumen ratio was 1.18 (95% CI, 1.11 to 1.27) and for arterial mass 1.28 (95% CI, 1.19 to 1.37). Additional analyses indicated that the CIMT-to-lumen ratio at lower CIMT levels appears to reflect arterial remodelling rather than risk of cardiovascular disease. We conclude that using the CIMT-to-lumen ratio yields the weakest associations. Other approaches for adjustment for common carotid lumen diameter do not affect the magnitude or precision of the association of common CIMT to risk of AMI. When the interest is in risk relations the preference goes to either CIMT or arterial mass measurement.