Left Common Carotid Artery Intima-media Thickness Research Articles

Left versus right carotid artery IMT: differential impact of age, gender, and cardiovascular risk factors.

Carotid artery intima-media thickness (IMT), an important clinical marker of atherosclerosis, is used widely in screening for cardiovascular risk and prognosis. Measurements of carotid artery IMT are made on both the left and right sides of the body, however as per the Mannheim consensus, an average of these measurements is usually reported. Nevertheless, there is considerable debate whether there are side differences in the carotid artery IMT in terms of both measurements and determinants. In a large sample of Caucasian patients (n = 1888) referred for cardiovascular risk assessment, we compared the left and the right common carotid artery IMT measurements, and assessed whether age, gender and cardiovascular risk factors have differential effects. We found that the left common carotid artery IMT (0.7141 ± 0.1733mm) is larger than the right (0.6861 ± 0.1594, p < 0.0001), but not in the young (< 30years) or the elderly (> 69years), and that this side difference is less in women (0.019 ± 0.116mm) than in men (0.036 ± 0.148mm, p < 0.001). In addition to age (p < 0.0001) and gender (p < 0.0001), the left common carotid artery IMT was determined by dyslipidaemia (protective, p = 0.016) and diabetes mellitus (p = 0.022); whereas the right common carotid artery IMT was determined by hypertension (p = 0.0002). The differential determinants of left versus right common carotid artery IMT were similar in men and women, and in young and old. In conclusion, side differences in measurements of the common carotid artery IMT depend upon age and gender. In addition, cardiovascular risk factors have differential effects on the left and right common carotid artery IMT.

Association Between the Common Carotid Artery Intima-Media Thickness and Glucose Metabolism in Obese Children

Objectives: To determine the relationship between glucose metabolism and atherosclerosis assessed according to the common carotid artery intima-media thickness (CIMT) in non-diabetic obese children. Methods: We performed anthropometric measurements and laboratory tests, including the oral glucose tolerance test (OGTT). The CIMTs on both sides were measured in obesity (body mass index [BMI] ≥ 95 percentile) children by one researcher. Results: There were 44 boys and 22 girls, and the mean age was 10.73 ± 2.48 years (range, 8 - 14 years). The mean CIMT on both sides, age, BMI, blood pressure, lipid profile, OGTT results, and HbA1c level were not significantly different between the boys and girls. Simple correlation analyses showed that the fasting plasma glucose (PG) level (γ = 0.266, P = 0.034), PG at 90 min (γ = 0.318, P = 0.014), PG at 120 min (γ = 0.336, P = 0.009), HbA1c level (γ = 0.306, P = 0.015), PG increase at 90 min (PGΔ90) (γ = 0.310, P = 0.017), and PGΔ120 (γ = 0.338, P = 0.009) were significantly correlated with the left CIMT. In multiple regression analysis, the HbA1c level, PGΔ90, and PGΔ120 were significantly associated with the left CIMT (P < 0.01). Conclusions: Ultrasound-measured CIMT, especially the left CIMT, is a reasonable glucose metabolic indicator of atherosclerotic vascular complications in obese children.

Prevalence of heterozygous familial hypercholesterolemia and combined hyperlipidemia phenotype in very young survivors of myocardial infarction and their association with the severity of atheromatous burden

Heterozygous familial hypercholesterolemia (HeFH) and combined hyperlipidemia (CHL) phenotype are associated with premature myocardial infarction (MI). To assess the prevalence of HeFH and CHL phenotype among young survivors of MI and compare patients' characteristics with these 2 lipid disorders. We recruited 382 young survivors of MI (≤40years). Fasting lipids, lipoprotein(a) [Lp(a)], apolipoprotein A-1, and apolipoprotein B (apoB) levels were determined. Using the Dutch Lipid Clinic Network (DLCN) algorithm, patients having definite or probable HeFH were identified. Patients with apoB levels >120mg/dL and triglyceride levels >170mg/dL (1.92mmol/L) [>90th percentile of 326 age and sex-matched healthy controls] were classified as having CHL phenotype. Common carotid artery intima-media thickness (CCA-IMT) was measured by B-mode ultrasonography. Eighty-one patients (21.2%) had definite/probable HeFH and 62 (16.2%) had CHL phenotype. Twenty-three patients fulfilled the criteria for both HeFH and CHL phenotype and were removed from further comparisons. Patients with HeFH (n=58) had higher levels of total cholesterol, low-density lipoprotein (LDL)-cholesterol, Lp(a), and apoB, whereas patients with CHL phenotype (n=39) had higher levels of triglycerides and lower high-density lipoprotein (HDL)-cholesterol levels. The prevalence of metabolic syndrome was higher in patients with CHL phenotype compared to those with HeFH (67.0% vs 16.4%, P<.001). Patients with HeFH had more extensive coronary artery disease (3-vessel disease: 36.2% vs 12.8%, P=.011) and greater right CCA-IMT (0.67±0.11mm vs 0.56±0.09mm, P<.001) and left CCA-IMT (0.68±0.10mm vs 0.56±0.08mm, P<.001) compared to CHL phenotype patients. Both HeFH and CHL phenotype are common among patients with premature MI. CHL phenotype compared to HeFH is associated with less atheromatous burden in coronary and carotid arteries at the time of first MI.

Relationship of short-term blood pressure variability with carotid intima-media thickness in hypertensive patients.

BackgroundHigh blood pressure (BP) is among significant risk factor for stroke and other vascular occurrences, it experiences nonstop fluctuations over time as a result of a complex interface among cardiovascular control mechanisms. Large blood pressure variability (BPV) has been proved to be promising in providing potential regulatory mechanisms of the cardiovascular system. Although the previous studies also showed that BPV is associated with increased carotid intima-media thickness (IMT) and plaque, whether the correlation between variability in blood pressure and left common carotid artery-intima-media thickness (LCCA-IMT) is stronger than right common carotid artery-intima-media thickness (RCCA-IMT) remains uncertain in hypertension.MethodsWe conduct a study (78 hypertensive subjects, aged 28–79) to evaluate the relationship between BPV and carotid intima-media thickness in Shenzhen. The blood pressure was collected using the 24 h ambulatory blood pressure monitoring, and its variability was evaluated using standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) during 24 h, daytime and nighttime. All the IMT measurements are collected by ultrasound.ResultsAs the results showed, 24 h systolic blood pressure variability (SBPV) evaluated by SD and ARV were significantly related to LCCA-IMT (r1 = 0.261, P = 0.021; r1 = 0.262, P = 0.021, resp.). For the daytime diastolic blood pressure variability (DBPV), ARV indices were significantly related to LCCA-IMT (r1 = 0.239, P = 0.035), which differed form BPV evaluated by SD and CV. For the night time, there is no significant correlation between the BPV and IMT. Moreover, for all the subjects, there is no significant correlation between the BPV and RCCA-IMT/number of plaques, whereas, the SD, CV, and ARV of daytime SBP showed a positive correlation with LCCA-IMT (r1 = 0.312, P = 0.005; r1 = 0.255, P = 0.024; r1 = 0.284, P = 0.012, resp.). Moreover, the ARV of daytime SBPV, 24 h SBPV and nighttime DBPV showed a positive correlation with the number of plaques of LCCA (r1 = 0.356, P = 0.008; r1 = 0.297, P = 0.027; r1 = 0.278, P = 0.040, resp.). In addition, the number of plaques in LCCA had higher correlation with pulse pressure and diastolic blood pressure than that in RCCA. And multiple regression analysis indicated LCCA-IMT might not only be influenced by age or smoking but also by the SD index of daytime SBPV (p = 0.035).ConclusionsThe results show that SBPV during daytime and 24 h had significant correlation with IMT, for the hypertensive subjects from the southern area of China. Moreover, we also found the daytime SBPV to be the best predictor for the progression of IMT in multivariate regression analysis. In addition, the present study suggests that the correlation between BPV and left common carotid artery—intima-media thickness/number of plaques is stronger than right common carotid artery-intima-media thickness/number of plaques.

Comparison of Brachial Artery Resistive Index with Intima-Media Thickness of Carotid Artery as Sonographic Markers of Atherosclerosis

Background and objective: Intima-media thickness (IMT) in common carotid artery (CCA) can be assessed during carotid arterial ultrasonography. However, it's association with resistive index (RI) in brachial artery (BA), as a useful tool to evaluate atherosclerosis progression has not been clarified well. The aim of this study was to examine the relationship between IMT in CCA and RI in BA. Material and methods: IMT and RI of CCA and BA were evaluated in 90 men with 30 control carotids, 30 mild carotid stenosis, and 30 severe stenosis using B-mode and Doppler ultrasonography. RI was measured based on the peak-systolic and different parts of diastolic velocities in Doppler spectrum in BA. Results: The intima-media thickness of the left common carotid Artery (LCCA) increased from 0.57 ± 0.14 in the control group to 0.73 ± 0.15 in the mild stenosis group and 0.90 ± 0.11 in the severe stenosis group. RId-end and RId-mean of the left brachial artery (LBA) increased from 0.85 ± 0.09 and 0.82 ± 0.05 in the control groups to 0.89 ± 0.08 and 0.85 ± 0.04 in the mild stenosis groups and 0.94 ± 0.06 and 0.89 ± 0.04 among sever groups, respectively. Conclusion: Between experimental groups, there was a significant difference in IMT of LCCA and RI of LBA, separately (p-value < 0.05). The Pearson correlation analysis showed a significant correlation between IMT of LCCA and RI of LBA. The brachial artery resistive index is associated with intima-media thickness of common carotid artery. This study showed that atherosclerosis was a generalized process that might involve the entire vasculature. Besides, we propose that RI measurements from each of the Doppler velocity spectrums of brachial artery and their averaging (RImean) may be a better index for explaining progression of atherosclerosis in brachial artery rather than RId-end alone. Due to the above-mentioned matters, it seems that RI in BA with accompaniment of IMT in CCA could be a useful tool to evaluate atherosclerosis progression. Copyright © 2015 American Scientific Publishers.

Role of Serum TNFα Level in Atherosclerosis in Egyptian Systemic Lupus Erythematosus Patients

Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease that principally affects women in their childbearing years. Many cytokines have been implicated in regulating disease activity and the involvement of different organs in patients with SLE. The study was conducted to determine serum tumor necrosis factor alpha (TNFα) levels in SLE patients and its relation to clinically active disease and to assess the possible role of serum TNFα level in atherosclerosis. Thirty Egyptian female patients with SLE and 15 matched healthy control subjects had serum TNFα levels measured. In addition, the relation of common carotid artery intima-media thickness (CIMT) to serum TNFα was evaluated. Mean serum TNFα level of SLE patients was 48.36 ± 58.27 pg/ml, significantly different from the control group (17.62 ± 16.63 pg/ml; P = .014). There was a statistically significant difference in right carotid CIMT between SLE patients (0.06 ± 0.01 cm) and the control group (0.054 ± 0.009; P = .002). There was also a statistically significant difference in left carotid CIMT between lupus nephritis patients (0.07 ± 0.01) and non–lupus nephritis patients (0.06 ± 0.01; P = .027). These data indicate the activation of immune response in SLE patients suggested by their high levels of TNFα. Increased CITM in lupus patients was not related to TNFα and the lipid profile, suggesting an underlying etiology for atherosclerosis in lupus patients other than those factors. High CIMT in nephritis patients denote the role of nephritis in atherosclerosis.

Comparison of different edge detections and noise reduction on ultrasound images of carotid and brachial arteries using a speckle reducing anisotropic diffusion filter.

Background:Common carotid artery (CCA) ultrasound with measurement of intima-media thickness (IMT) is a safe and noninvasive technique for assessing subclinical atherosclerosis and determining cardiovascular risks. Moreover, the pattern of wall thickening in the brachial artery (BA) is rather diffuse compared to the carotid artery and may be a more sensitive indicator of long-term systemic exposure to risk factors. Therefore noninvasive evaluation of mechanical parameters changes of both arteries has gained the attention of researchers.Objectives:The aim of this study was to compare different edge detection techniques with speckle reducing anisotropic diffusion (SRAD) de-noising filter in ultrasound images of both arteries.Patients and Methods:In a cross-sectional design, an examination was performed on ten men with mean age of 40 ± 5 years from September 2012 to March 2013 through random sampling. An ultrasonic examination of the left CCA and BA was performed. The program was designed in the MATLAB software to extract consecutive images in JPEG format from the AVI. Another program was designed in the MATLAB software to apply regions of interest (ROI) on the IMT of the posterior wall of common carotid and brachial arteries. Next, different edge detections and SRAD filter were applied to the ROI, separately. Finally, the program measured mean-squared error (MSE) and peak signal to noise ratio (PSNR).Results:The lowest values of MSE and highest values of PSNR were achieved by Canny edge detection with de-noising SRAD filter for IMT of left CCA and BA in 90 frames.Conclusions:Based on the result, by measuring the MSE and PSNR, this study showed Canny edge detection with SRAD filter is better than other edge detections in terms of speckle suppression and details preservation in CCA and BA ultrasound images.

CLINICAL IMPORTANCE OF ASYMMETRYAND HANDEDNESS DIFFERENCES IN COMMON CAROTID ARTERY INTIMA-MEDIA THICKNESS

Earlier publications have reported that common carotid artery intima-media thickness (CCA-IMT) was lower on the right side than on the left side and that left-handed patients have a lower risk of sudden death of brain infarction. This study aimed to determine whether there is an asymmetry and the handedness related difference in CCA-IMT. Ultrasonographic examinations were performed with the use of Aplio US system. In total sample, male and female left-handers, CCA-IMT was greater on left side than on right side. In men, both right and left CCA-IMTs, but in women only right IMT, were lower in the left-handers than in the right-handers. Both right and left CCA-IMTs was positively correlated with age in men and in women. Handedness was a significant factor influencing CCA-IMT with adjustment for sex and age. It was greater on left side than on right side, especially in the left-handers. CCA-IMTs were lower in the left-handers than in the right-handers. These results suggest that hemodynamic stress and intimal damage was larger in the left carotid artery, which was larger in the right-handers compared to the left-handers.