Intima-media Thickness Variability Research Articles

Ultrasound Examination of Common Carotid Adventitial Thickness Can Differentiate Takayasu Arteritis and Large Vessel Giant Cell Arteritis.

Pathological studies have demonstrated that the adventitial layer is markedly thickened in Takayasu (TAK) as compared to large vessel giant cell arteritis (LV-GCA). An ultrasound (US) examination of the arterial vessels allows the determination of intima media thickness (IMT) and of adventitial layer thickness (extra media thickness (EMT)). No previous study has evaluated if there are differences in EMT thickness between TAK and LV-GCA. In this cross-sectional retrospective study of stored ultrasound (US) imaging, we have compared common carotid artery (CCA) EMT and IMT in a series of consecutive TAK and LV-GCA patients. US examination CCA IMT and EMT were significantly higher in TAK as compared to LV-GCA. With ROC curve analysis, we have found that an EMT > 0.76 mm has high sensitivity and specificity for TAK CCA examination. The percentage of CCA at EMT > 0.76 mm and the total arterial wall thickening were significantly higher in TAK group examinations. EMT thickness correlated with disease duration and IMT in the TAK group, as well as with the IMT and ESR values in the LV-GCA group. Upon multivariate logistic regression analysis, factors independently associated with TAK CCA were EMT > 0.76 mm and age. No significant variation in IMT and EMT could be demonstrated in subsequent US CCA examinations.

Impact of Lipids and Vascular Damage on Early Atherosclerosis in Adolescents with Parental Premature Coronary Artery Disease.

To assess the relationship of cardiovascular risk factors (CRFs) with carotid intima media thickness (IMT) in adolescents with a parental history of premature coronary artery disease (PCAD). This cross-sectional study included 50 healthy adolescents, aged 14-18years, both sexes, with a parental history of PCAD, that were compared to 50 controls without this history. Questionnaires regarding information of CRFs were applied. Blood chemistry analyses, included lipid profile, lipoprotein (a), low density lipoprotein (LDL) susceptibility to oxidation, and inflammatory cytokine levels. The IMT was evaluated by ultrasound. The mean age of all participants was 15.9years. Anthropometric measurements, blood pressure, and lipid profile were similar in both groups. However, the parental history of PCAD group exhibited lower high density lipoprotein cholesterol concentrations, shorter LDL particle oxidation time, and higher lipoprotein (a) levels compared to the control group. IMT was significantly higher in adolescents with a parental history of PCAD compared to controls, (0.53±0.04mm vs 0.47±0.02mm, p=0.001). Among adolescents with a parental history of PCAD, those with ≥3 CRFs had significantly higher IMT values (0.56mm) than those with <3 CRFs (0.52mm) and controls (0.48mm). Multivariable analyses identified that systolic blood pressure and parental history of PCAD explained 26.8% and 16.1% of the variation in IMT. Furthermore, body mass index, LDL-C, ApoB-100, triglycerides and lipoprotein (a) interact with blood pressure levels to explain the IMT values. Adolescents with a parental history of PCAD had higher IMT values than the control group, primary explained by systolic blood pressure and the parental inheritance. Adolescents with parental history of PCAD and ≥3 CRFs exhibited the highest IMT values. Notably, lipids and systolic blood pressure jointly contribute to explain IMT in these adolescents.

Preliminary study of carotid variables under ultrasound analysis as predictors for the risk of coronary arterial atherosclerosis.

BackgroundCarotid atherosclerosis by ultrasound scanning can be considered as an ideal window to reflect systemic artery atherosclerosis, which has aroused wide concern for predicting the severity of coronary artery atherosclerosis clinically. Ultrasound radio frequency (RF) data technology has enabled us to evaluate the carotid structure and elastic function precisely, for predicting the severity of coronary artery atherosclerosis.MethodsPatients with suspected coronary artery disease (CAD) underwent coronary angiography and were assigned to four groups according to whether atherosclerotic plaque was found or not and it caused stenosis. Carotid artery intima‐media thickness (IMT) and arterial stiffness were investigated by quality intima‐media thickness (QIMT) and quality arterial stiffness (QAS) techniques during ultrasound scanning. Univariable and multivariable modeling were used to investigate correlations of carotid parameters to coronary artery atherosclerosis. Receive operating characteristic (ROC) curves were used to evaluate diagnostic performance of these ultrasound variables.ResultsCarotid IMT and stiffness variables pulse wave velocity (PWV), α, β and compliance coefficient (CC) were statistically different between every two‐group's comparisons. IMT correlated with stiffness variables significantly with r = 0.70, 0.77, 0.63, and −0.39, respectively. All variables correlated with the severity of coronary atherosclerosis with the odd ratio (OR) of 1.73, 1.67, 1.19, 1.23, and 0.56 accordingly as IMT, PWV, α, β and CC were concerned. The AUC of IMT, PWV, α, β and CC were 0.9257, 0.8910, 0.8016, 0.9383, 0.8581 with correctly classified rate of 88.16%, 83.77%, 78.07%, 86.84%, and 81.58%, respectively.ConclusionsCarotid artery IMT and stiffness variable PWV, α, β and CC presented favorable predicting and differentiating values for patients with coronary atherosclerosis of different severity.

The personality meta-trait of stability and carotid artery atherosclerosis.

Several personality traits increase the risk for atherosclerotic cardiovascular disease. Because many of these traits are correlated, their associations with disease risk could reflect shared variance, rather than unique contributions of each trait. We examined a higher-order personality trait of Stability as related to preclinical atherosclerosis and tested whether any such relationship might be explained by correlated variation in cardiometabolic risk factors. Among 798 community volunteers, lower-order traits of Neuroticism, Agreeableness, and Conscientiousness were modeled as latent variables (from self- and informant ratings) and used to estimate the second-order factor, Stability. Cardiometabolic risk was similarly modeled from indicators of glycemic control, blood pressure, adiposity, and lipids. Carotid artery atherosclerosis was measured as intima-media thickness (IMT) by duplex ultrasonography. A structural equation model incorporating direct and indirect effects showed lower Stability associated with greater IMT, and this relationship was accounted for by the indirect pathway via cardiometabolic risk. Secondary analyses showed that: (1) Neuroticism, Agreeableness, and Conscientiousness were unrelated to IMT independent of Stability; and (2) Stability predicted variation in IMT when estimated from informant-, but not self-rated, traits. Personality traits may associate with atherosclerotic burden through their shared, rather than unique, variance, as reflected in Stability.

3043Endotrophin, a fragment of collagen type VI, is correlated to IMT and associated with cardiovascular events in patients with atherosclerosis and diabetes: the IMI-SUMMIT cohort

Abstract Background/Introduction Patients with micro- and macrovascular diseases, including atherosclerosis, have increased risk of cardiovascular events and early mortality. The atherosclerotic disease is characterised by accumulation of lipids, cells and proteins in the arterial wall, which includes remodelling of the extracellular matrix (ECM). Collagen type VI (COL6) is known to be over-expressed in patients with atherosclerosis. The biomarker PRO-C6, known as endotrophin, is a COL6 fragment that reflects formation of collagen type VI, and possess pro-inflammatory and pro-fibrotic activities. Purpose We explored whether increased endotrophin levels, measured by PRO-C6, were associated with intima-media thickness (IMT) and mortality in the IMI-SUMMIT cohort. Methods Circulating protein levels of PRO-C6 were measured in EDTA plasma from 1500 patients enrolled at four European University Hospitals, using an enzyme-linked immunosorbent assay. Follow-up data were available up to three years after sample collection. Associations between PRO-C6 and incidence of cardiovascular (CV) events and all-cause mortality were assessed by Kaplan-Meier curves and Cox proportional hazard regression analyses. Pearson correlation was performed to explore the association of PRO-C6, IMT and clinical variables. Known confounders defined by the Framingham Heart study (age, gender and diabetes) were included in the Cox proportional hazard regression analysis. Results Plasma PRO-C6 was significantly correlated with IMT in both the common carotid artery and the carotid bulb (r=0.09, p=0.002 and r=0.11, p=0.0003, respectively), HbA1c (r=0.11, p&lt;0.0001) and C-reactive protein (r=0.14, p&lt;0.0001). A total of 145 patients suffered from fatal or non-fatal cardiovascular events during the three-year follow-up period. Patients in the highest PRO-C6 tertile had a two-fold increased risk of experiencing a CV event during follow-up (p=0.002), independently of age, presence of CVD at baseline, type 2 diabetes, smoking and statin treatment in a regression model. Conclusion The present findings demonstrate that circulating levels of PRO-C6 are associated with atherosclerosis severity and increased incidence of cardiovascular events. Since PRO-C6 detects the signaling molecule endotrophin, the results may indicate that endotrophin is not only a biomarker of atherosclerotic disease, but may have a role in promoting disease progression. Acknowledgement/Funding This work was supported by the Danish Research Foundation, The Danish innovation foundation and the IMI-SUMMIT participants

Ranking of stroke and cardiovascular risk factors for an optimal risk calculator design: Logistic regression approach

PurposeConventional cardiovascular risk factors (CCVRFs) and carotid ultrasound image-based phenotypes (CUSIP) are independently associated with long-term risk of cardiovascular (CV) disease. In this study, 26 cardiovascular risk (CVR) factors which consisted of a combination of CCVRFs and CUSIP together were ranked. Further, an optimal risk calculator using AtheroEdge composite risk score (AECRS1.0) was designed and benchmarked against seven conventional CV risk (CVR) calculators. MethodsTwo types of ranking were performed: (i) ranking of 26 CVR factors and (ii) ranking of eight types of 10-year risk calculators. In the first case, multivariate logistic regression was used to compute the odds ratio (OR) and in the second, receiver operating characteristic curves were used to evaluate the performance of eight types of CVR calculators using SPSS23.0 and MEDCALC12.0 with validation against STATA15.0. ResultsThe left and right common carotid arteries (CCA) of 202 Japanese patients were examined to obtain 404 ultrasound scans. CUSIP ranked in the top 50% of the 26 covariates. Intima-media thickness variability (IMTV) and IMTV10yr were the most influential carotid phenotypes for left CCA (OR = 250, P < 0.0001 and OR = 207, P < 0.0001 respectively) and right CCA (OR = 1614, P < 0.0001 and OR = 626, P < 0.0001 respectively). However, for the mean CCA, AECRS1.0 and AECRS1.010yr reported the most highly significant OR among all the CVR factors (OR = 1.073, P < 0.0001 and OR = 1.104, P < 0.0001). AECRS1.010yr also reported highest area-under-the-curve (AUC = 0.904, P < 0.0001) compared to seven types of conventional calculators. Age and glycated haemoglobin reported highest OR (1.96, P < 0.0001 and 1.05, P = 0.012) among all other CCVRFs. ConclusionAECRS1.010yr demonstrated the best performance due to presence of CUSIP and ranked at the first place with highest AUC.

B-Mode ultrasound assessment of intima-media thickness of common carotid, internal carotid, brachial, femoral arteries and abdominal aorta in patients with cardiovascular risk factor

Aim: The aim of the present study was to assess the association between common carotid intima-media thickness (IMT) and vascular IMT values measured from different anatomic regions.Methods: We prospectively included 256 patients. The IMT values of the common carotid and internal carotid, brachial and femoral artery and abdominal aorta were measured by B-mode ultrasound (CC-IMT, IC-IMT, B-IMT, F-IMT and A-IMT). Patients were divided into two groups as increased and normal CC-IMT. Results: Increased CC-IMT was detected in 55 of 256 patients (21.5%). All IMT variables showed a positive correlation with CC-IMT. Femoral IMT was independently associated with increased CC-IMT. In regression model, each 0.1 mm increase in F-IMT increased the risk of increased CC-IMT by 70.2%. When F-IMT value 1.1 mm was accepted as a cut-off value for the prediction of increased CC-IMT, sensitivity and specificity were 96.4% and 90%, respectively. In ROC curve analyses, the area under curve was calculated as 0.936. Conclusions: Another vascular IMT location presenting increased CC-IMT best is F-IMT. The limit value for increased F-IMT &gt;1.1mm may be used in practice. The CC-IMT measurement is closely and positively associated with all other vascular IMT measurements.

A dynamic ultrasound simulation of a pulsating three-layered CCA for validation of two-dimensional wall motion and blood velocity estimation algorithms.

A dynamic ultrasound simulation model for the common carotid artery (CCA) with three arterial layers for validation of two-dimensional wall motion and blood velocity estimation algorithms is proposed in the present study. This model describes layers with not only characteristics of echo distributions conforming to clinical ones but also varying thicknesses, axial, and radial displacements with pulsatile blood pressure during a cardiac cycle. The modeling process is as follows: first, a geometrical model according with the clinical structure size of a CCA is built based on the preset layer thicknesses and the diameter of lumen. Second, a three-dimensional scatterer model is constructed by a mapping with a Hilbert space-filling curve from the one-dimensional scatterer distribution with the position and amplitude following Gamma and Gaussian distributions, respectively. The characteristics of three layers and blood are depicted by smoothly adjusting the scatterer density, the scale, and shape parameters of the Gamma distribution as well as the mean and standard deviation of the Gaussian distribution. To obtain the values of parameters of scatterer distributions, including the shape parameter, density, and intensity, for arterial layers and blood, the envelope signals simulated from different configurations of scatterer distribution are compared with those from different kinds of tissue of CCAs in vivo through a statistic analysis. Finally, the dynamic scatterer model is realized based on the blood pressure, elasticity modulus of intima-media (IM) and adventitia, varying IM thickness, axial displacement of IM as well as blood flow velocity at central axis during a cardiac cycle. Then, the corresponding radiofrequency (RF) signals, envelope signals, and B-mode images of the pulsatile CCA are generated in a dynamic scanning mode using Field II platform. The three arterial layers, blood, and surrounding tissue in simulated B-mode ultrasound images are clearly legible. The results based on a statistical analysis for the envelope signals from 30 simulations indicate that the echo characteristics of blood, intima, media, and adventitia are in accordant with clinical ones. The maximum relative errors between the preset geometrical sizes and the measured ones from the simulated images for the diameter of the lumen and the thicknesses of the intima, media, and adventitia are 0.13%, 3.89%, 1.35%, and 0.06%, respectively. For the dynamic parameters, the variation in IM thickness, the radial displacements of lumen and adventitia as well as the axial displacement of IM and blood flow velocity are measured with the mean relative errors of 68.03%, 9.27%, 2.10%, 4.93%, and 17.34%, respectively. The simulated results present static sizes and dynamical variations according with preset values; echo distributions conforming to clinical versions. Therefore, the presented simulation model could be useful as a data source to evaluate the performance of studies on measurements of ultrasound-based tissue structures and dynamic parameters for the CCA layers.

Validation of the Carotid Intima–Media Thickness Variability: Can Manual Segmentations Be Trusted as Ground Truth?

The common carotid artery intima–media thickness (IMT) is widely accepted and used as an indicator of atherosclerosis. Recent studies, however, have found that the irregularity of the IMT along the carotid artery wall has a stronger correlation with atherosclerosis than the IMT itself. We set out to validate IMT variability (IMTV), a parameter defined to assess IMT irregularities along the wall. In particular, we analyzed whether or not manual segmentations of the lumen–intima and media–adventitia can be considered reliable in calculation of the IMTV parameter. To do this, we used a total of 60 simulated ultrasound images with a priori IMT and IMTV values. The images, simulated using the Fast And Mechanistic Ultrasound Simulation software, presented five different morphologies, four nominal IMT values and three different levels of variability along the carotid artery wall (no variability, small variability and large variability). Three experts traced the lumen–intima (LI) and media–adventitia (MA) profiles, and two automated algorithms were employed to obtain the LI and MA profiles. One expert also re-traced the LI and MA profiles to test intra-reader variability. The average IMTV measurements of the profiles used to simulate the longitudinal B-mode images were 0.002 ± 0.002, 0.149 ± 0.035 and 0.286 ± 0.068 mm for the cases of no variability, small variability and large variability, respectively. The IMTV measurements of one of the automated algorithms were statistically similar (p > 0.05, Wilcoxon signed rank) when considering small and large variability, but non-significant when considering no variability (p < 0.05, Wilcoxon signed rank). The second automated algorithm resulted in statistically similar values in the small variability case. Two readers' manual tracings, however, produced IMTV measurements with a statistically significant difference considering all three variability levels, whereas the third reader found a statistically significant difference in both the no variability and large variability cases. Moreover, the error range between the reader and automatic IMTV values was approximately 0.15 mm, which is on the same order of small IMTV values, indicating that manual and automatic IMTV readings should be not used interchangeably in clinical practice. On the basis of our findings, we conclude that expert manual tracings should not be considered reliable in IMTV measurement and, therefore, should not be trusted as ground truth. On the other hand, our automated algorithm was found to be more reliable, indicating how automated techniques could therefore foster analysis of the carotid artery intima–media thickness irregularity.

Relationship between leukoaraiosis, carotid intima-media thickness and intima-media thickness variability: Preliminary results.

To assess the relationship between the degree of leukoaraiosis (LA), carotid intima-media thickness (IMT) and intima-media thickness variability (IMTV). Sixty-one consecutive patients, who underwent a brain MRI examination and a carotid artery ultrasound, were included in this retrospective study, which conformed with the Declaration of Helsinki. Written informed consent was waived. In each patient, right/left carotid arteries and brain hemispheres were assessed using automated software for IMT, IMTV and LA volume. The mean hemispheric LA volume was 2,224mm3 (SD 2,702mm3) and there was no statistically significant difference in LA volume between the right and left hemispheres (p value = 0.628). The mean IMT and IMTV values were 0.866mm (SD 0.170) and 0.143mm (SD 0.100), respectively, without significant differences between the right and left sides (p values 0.733 and 0.098, respectively). The correlation coefficient between IMTV and LA volume was 0.41 (p value = 0.0001), and 0.246 (p value = 0.074) between IMT and LA volume. IMTV significantly correlates with LA volume. Further studies are warranted to verify whether this parameter can be used clinically as a marker of cerebrovascular risk. • Intima-media thickness variability (IMTV) significantly correlates with leukoaraiosis volume. • IMTV could be used as a marker for cerebrovascular risk. • IMTV seems to be a better predictor of weighted mean difference than IMT.

ULTRASOUND B-MODE DESCRIPTORS AND THEIR ASSOCIATION TO AGE AND AUTOMATED IMT AND IMT VARIABILITY

The aim of this paper is to evaluate the association between four simple B-mode image descriptors and age, to further assess the association between the descriptors and automated intima-media thickness (IMT) and intima-media thickness variability (IMTV) measurements, and finally analyze the predictive value of the B-mode image descriptors. A database of 1774 images of the carotid artery is used to manually calculate the contrast and the signal-to-noise ratio (SNR) between the (i) intima-media complex and lumen, and (ii) adventitial wall layer and intima-media complex. A subset of 200 images is then used to automatically measure the IMT and IMTV parameters with a previously developed algorithm. Correlation studies and logistic regression analysis are then performed. The contrast and SNR between the intima-media complex and lumen (contrastIM and SNRIM) are 112.691[Formula: see text][Formula: see text][Formula: see text]247.427 and 19.542[Formula: see text][Formula: see text][Formula: see text]6.236, respectively; whereas between the adventitial wall layer and intima-media complex the parameters (contrastADV and SNRADV) are found to be 1.684[Formula: see text][Formula: see text][Formula: see text]1.182 and 32.859[Formula: see text][Formula: see text][Formula: see text]10.766, respectively. Pearson’s rho is significantly different from zero considering the contrastIM and the SNRADV descriptors when tested for the association with age. The automated IMT and IMTV measurements are 0.796[Formula: see text][Formula: see text][Formula: see text]0.152[Formula: see text]mm and 0.096[Formula: see text][Formula: see text][Formula: see text]0.044[Formula: see text]mm, respectively. Testing the association with the IMT and IMTV measurements yielded Pearson’s rho values which are significantly different from zero except in the case of contrastIM for the IMTV measurement. The logistic regression results showed the IMTV measurement and the SNR descriptor between the intima-media complex and the lumen has a significant predictive value. Considering the association between the IMT and IMTV, the B-mode image descriptors showed a strong and statistically significant association. Moreover, the SNR between the intima-media complex and lumen is found to be a predictive variable in demonstrating its effectiveness as an image descriptor.

Associations of Coronary Heart Disease with Common Carotid Artery Near and Far Wall Intima-Media Thickness: The Multi-Ethnic Study of Atherosclerosis.

Intima-media thickness (IMT) measured on ultrasound images of the common carotid artery (CCA) is associated with cardiovascular risk factors and events. Given the physics of ultrasound, CCA far wall IMT measurements are favored over near wall measurements, but this theoretical advantage is not well studied. A total of 6,606 members of the Multi-Ethnic Study of Atherosclerosis, a longitudinal cohort study (mean age, 62.1years; 52.7% women) who had near wall and far wall CCA IMT measurements. Multivariate linear regression models were used to estimate model goodness of fit of Framingham risk factors with near wall IMT, far wall IMT, and combined mean IMT. Multivariate Cox proportional hazards models were used to estimate hazard ratios for incident coronary heart disease events for each IMT variable. Change in Harrell's C statistic was used to compare the incremental value of each IMT variable when added to Framingham risk factors. Mean IMT had the strongest association with risk factors (R(2)=0.31), followed by near wall (R(2)=0.26) and far wall (R(2)=0.22) IMT. Far wall IMT improved the prediction of coronary artery disease events over the Framingham risk factors (change in C statistic, 0.012; 95% CI, 0.006-0.017; P<.001), as did mean IMT (P=.004), but near wall IMT did not. Far wall CCA IMT showed the strongest association with incident coronary heart disease, whereas mean IMT had the strongest associations with risk factors. This difference might affect the selection of appropriate IMT variables in different studies.

An automated technique for carotid far wall classification using grayscale features and wall thickness variability.

To test a computer-aided diagnostic method for differentiating symptomatic from asymptomatic carotid B-mode ultrasonographic images. Our system (called Atheromatic) automatically computed the intima-media thickness (IMT) of the carotid far wall using AtheroEdge, calculated nonlinear features based on higher order spectra, and used these features and IMT and IMT variability (IMTVpoly ) to associate each image to a feature vector that was then labeled as symptomatic or asymptomatic (Sym/Asym) by a multiclassifiers system. We tested this method on a database of 118 carotid artery images from 37 symptomatic and 22 asymptomatic patients The highest accuracy (99.1%) was obtained by the support vector machine classifier using seven features. These features, relevant to discriminate Sym/Asym, included IMT and IMTVpoly , along with the bispectral entropies of the distal wall image at 77°, 78°, and 79° angles. Classification in Sym/Asym of the far carotid wall is feasible and accurate and could be useful for the early detection of atherosclerosis and to identify patients with higher cardiovascular risk.

AB0688 Carotid Intima-Media Thickness in Spondyloarthritis: Prevalence of Subclinical Atherosclerosis in Patients without Clinically Evident Cardiovascular Disease

BackgroundAS and PsA patients without clinically evident cardiovascular disease have a high prevalence of subclinical cardiovascular disease in form of increased carotid intima-media thickness (IMT) and carotid plaques compared to...

Abstract P331: Associations Of Coronary Heart Disease With Common Carotid Artery Near And Far-wall Intima-Media Thickness (IMT): The Multi-Ethnic Study Of Atherosclerosis.

Background: Intima-media thickness (IMT) as measured on ultrasound images of the common carotid artery (CCA) is associated with cardiovascular events and used to measure the effects of lipid lowering interventions. Far wall CCA IMT is favored over near wall IMT based on the physics of ultrasound. Materials and Methods: We studied 6606 members of the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal cohort study (mean age 62.1 years; 52.7% female) who had near wall and far wall CCA IMT measurements. Multivariable linear regression models were used to estimate model goodness-of-fit of near wall IMT, far wall IMT, and mean IMT with Framingham risk factors (FRF). Multivariable Cox proportional hazards models were used to estimate hazard ratios for incident coronary heart disease (CHD) events for each IMT variable. Change in Harrell’s C-statistic was used to compare the incremental value of each IMT variable when added to FRF. Results: Mean IMT had the strongest association with risk factors (R2 = 0.31), followed by the near wall (R2 = 0.26) and far wall IMT (R2 = 0.22). Far wall IMT improved the prediction of coronary artery disease events (change in C statistic: 0.009; 95% Confidence Intervals: 0.004, 0.015; p= 0.001) as did mean IMT (p=0.033) but near wall IMT did not. Conclusion: Far wall CCA IMT had the strongest association with incident CHD whereas combined near wall and far wall IMT had the strongest association with risk factors. Selected IMT variables may give different results in intervention trials than in outcome studies.

Ankle–Brachial Index and Its Link to Automated Carotid Ultrasound Measurement of Intima–Media Thickness Variability in 500 Japanese Coronary Artery Disease Patients

The purpose of this study was to evaluate whether the carotid intima-media thickness (cIMT) and intima-media thickness variability (IMTV) along the artery are correlated to the ankle-brachial index (ABI) in Japanese coronary artery disease patients. Five hundred consecutive patients (312 males; median age 69 ± 11 years) who underwent carotid ultrasonography and first coronary angiography were prospectively analyzed. By using automated software (AtheroEdge™, AtheroPoint, Roseville, CA, USA), we obtained the cIMT and IMTV. Pearson correlation analysis was performed to calculate the association between ABI, automatically measured cIMT, automatically measured IMTV, and the SYNTAX score. The mean cIMT was 0.881 ± 0.334 mm and the mean IMTV was 0.141 ± 0.112. IMTV was negatively and significantly correlated to ABI (ρ = -0.147; p = 0.001), whereas cIMT was not (ρ = -0.075; p = 0.097). IMTV and cIMT had the same significant correlation with the SYNTAX score. When we considered patients with a higher risk factor (ABI ≤ 0.9), we found higher values of IMTV and the SYNTAX score, but not higher values of cIMT. Logistic regression analysis showed that IMTV was independently associated with the complexity of the coronary artery disease (as assessed by the SYNTAX score). In conclusion, we show that IMTV automatically measured using AtheroEdge™ was correlated with ABI, whereas cIMT was not. IMTV could be integrated with cIMT measurement to improve the assessment of cardiovascular disease.

Carotid IMT Variability (IMTV) and Its Validation in Symptomatic versus Asymptomatic Italian Population: Can This Be a Useful Index for Studying Symptomaticity?

The carotid intima-media thickness (IMT) is a validated marker of cerebrovascular disease risk. This paper presents a new parameter, the IMT variability (IMTV), and compares it between symptomatic and asymptomatic patients taken from a cohort of Italian population. One hundred forty-two patients were analyzed (age 59 ± 112 years, 59% males), 42 of these patients suffered from TIA or minor stroke. The lumen-intima (LI) and media-adventitia (MA) interfaces of the far wall were manually traced by a Reader. We also used a computer-based automated system (called AutoEdge) to obtain the LI/MA interfaces. The LI/MA interfaces were used to measure the IMT and the IMTV along the distal wall of the common carotid artery. Wilcoxon and Pearson correlation analyses were performed. The agreement between the Reader's IMT and the AutoEdge IMT values was 98.7% for the symptomatic (0.83 ± 0.44 mm for Reader, 0.82 ± 0.35 mm for AutoEdge) and 94.9% for the asymptomatic patients (0.78 ± 0.45 mm for Reader, 0.74 ± 0.30 mm for AutoEdge). Correlation was 65% for symptomatic and 68% for asymptomatic patients, respectively. The IMT measured using AutoEdge was 1.2% lower compared to manual measurements in symptomatic population, while 5.12% lower in asymptomatic. The IMTV was 11% higher in symptomatic patients compared to asymptomatic when using manual delineations, 8% higher when using AutoEdge. There was no statistical difference between the manual and automated IMTV measurements (Wilcoxon signed rank, P > 0.7). We conclude that the IMT and IMTV values were very similar between Reader and AutoEdge software when studying symptomatic and asymptomatic patients in Italian population.

Relationships between high-sensitive C-reactive protein and markers of arterial stiffness in hypertensive patients. Differences by sex

BackgroundThe present study was designed to evaluate the relationship between high-sensitivity C-reactive protein (hs-CRP) and arterial stiffness according to sex in patients with arterial hypertension.MethodsA case-series study was carried out in 258 hypertensive patients without antecedents of cardiovascular disease or diabetes mellitus. Nephelometry was used to determine hs-CRP. Office or clinical and home blood pressures were measured with a validated OMRON model M10 sphygmomanometer. Ambulatory blood pressure monitoring was performed with the SpaceLabs 90207 system. Pulse wave velocity (PWV) and central and peripheral augmentation index (AIx) were measured with the SphygmoCor system, and a Sonosite Micromax ultrasound unit was used for automatic measurements of carotid intima-media thickness (IMT). Ambulatory arterial stiffness index and home arterial stiffness index were calculated as “1-slope” from the within-person regression analysis of diastolic-on-systolic ambulatory blood pressure.ResultsCentral and peripheral AIx were greater in women than in men: 35.31 ± 9.95 vs 26.59 ± 11.45 and 102.06 ± 20.47 vs 85.97 ± 19.13, respectively. IMT was greater in men (0.73 ± 0.13 vs 0.69 ± 0.10). hs-CRP was positively correlated to IMT (r = 0.261), maximum (r = 0.290) and to peripheral AIx (r = 0.166) in men, and to PWV in both men (r = 0.280) and women (r = 0.250). In women, hs-CRP was negatively correlated to central AIx (r = −0.222). For each unit increase in hs-CRP, carotid IMT would increase 0.05 mm in men, and PWV would increase 0.07 m/sec in men and 0.08 m/sec in women, while central AIx would decrease 2.5 units in women. In the multiple linear regression analysis, hs-CRP explained 10.2% and 6.7% of PWV variability in women and men, respectively, 8.4% of carotid IMT variability in men, and 4.9% of central AIx variability in women.ConclusionsAfter adjusting for age, other cardiovascular risk factors and the use of antihypertensive and lipid-lowering drugs, hs-CRP was seen to be positively correlated to carotid IMT in men, and negatively correlated to central AIx in women. The association of hs-CRP to arterial stiffness parameters differs between men and women.

Ambulatory arterial stiffness indices and target organ damage in hypertension

BackgroundThe present study was designed to evaluate which arterial stiffness parameter - AASI or the home arterial stiffness index (HASI) - correlates best with vascular, cardiac and renal damage in hypertensive individuals.MethodsA cross-sectional study was carried out involving 258 hypertensive patients. AASI and HASI were defined as the 1-regression slope of diastolic over systolic blood pressure readings obtained from 24-hour recordings and home blood pressure over 6 days. Renal damage was evaluated by glomerular filtration rate (GFR) and microalbuminuria; vascular damage by carotid intima-media thickness (IMT), pulse wave velocity (PWV) and ankle/brachial index (ABI); and left ventricular hypertrophy by the Cornell voltage-duration product (VDP) and the Novacode index.ResultsAASI and HASI were not correlated with microalbuminuria, however AASI and HASI- blood pressure variability ratio (BPVR) showed negative correlation with GRF. The Cornell PDV was positively correlated with AASI- BPVR-Sleep (r = 0.15, p < 0.05) and the left ventricular mass index with HASI-BPVR (r = 0.19, p < 0.01). Carotid IMT and PWV were positively correlated with all the parameters except the HASI, while ABI was negatively correlated with AASI and Awake-AASI. After adjusting for age, gender and 24 hours heart rate, statistical significance remains of the IMT with AASI, Awake AASI and AASI-BPVR. PWV with the AASI, Awake-AASI and Sleep-AASI. ABI with AASI and Awake-AASI. Odd Ratio to presence target organ damage was for AASI: 10.47(IC95% 1.29 to 65.34), Awake-AASI: 8.85(IC95% 1.10 to 71.04), Sleep-AASI: 2.19(IC95% 1.10 to 4.38) and AASI-BPVR-night: 4.09 (IC95% 1.12 to 14.92).ConclusionsAfter adjusting for age, gender and 24-hour heart, the variables that best associated with the variability of IMT, PWV and ABI were AASI and Awake-AASI, and with GFR was HASI-BPVR.

Smoking Attenuates the Beneficial Effect of Physical Activity on Intima-Media Thickness of Carotid Artery in Young and Middle-Aged Smokers

Background : Though the favorable effect of physical activity and the hazardous effect of smoking on the progression of atherosclerosis have been well studied, the interactive effect of the two factors has seldom been investigated. Methods : A total of 1,090 subjects from among examinees of screening for brain diseases (an annual medical checkup of the brain) from April 2007 to March 2008 were studied to clarify the effect of physical activity on current, former and never smokers in relation to maximum carotid intima-media thickness (IMT). Univariate and multivariate analyses were performed to investigate the relationship between maximum IMT and independent variables such as age, gender, coexisting disease, physical activity, alcohol drinking, family history, symptoms, BMI, systolic blood pressure, diastolic blood pressure, blood sugar, total cholesterol, HDL cholesterol, triglyceride, Bathel index and time since smoking cessation. Results : Univariate analysis revealed that only never smokers exhibited a significant relationship between physical activity and maximum IMT. Multiple regression analyses performed for three age specific groups ( ≤ 49, 50 - 59, ≥ 60), demonstrated that physical activity was not a significant predictor of maximum IMT in current and former smokers 49 years old and younger, and current smokers 50 - 59 years old, though the other multivariate analyses showed no meaningful results, including for never smokers. Conclusions : The present study revealed that for young and middle-aged current smokers, the favorable effect of physical activity on the prevention of carotid atherosclerosis might be attenuated by detrimental effect of smoking. doi:10.4021/jnr74w