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European Radiology

, Volume 29, Issue 3, pp 1507–1517 | Cite as

Carotid stiffness and atherosclerotic risk: non-invasive quantification with ultrafast ultrasound pulse wave velocity

  • Zheng-Qiu Zhu
  • Ling-Shan Chen
  • Han Wang
  • Fu-Ming Liu
  • Yun Luan
  • Lin-Lin Wu
  • Niu Liu
  • Pin Wang
  • Hui HuangEmail author
Ultrasound
  • 113 Downloads

Abstract

Objectives

To evaluate the value of ultrafast pulse wave velocity (ufPWV) for the quantitative assessment of carotid stiffness and its associated with atherosclerosis (AS) risk.

Methods

The present study included 233 patients with hyperlipoidaemia (AS risk group) and 114 healthy adults as the control group. The carotid (n = 694) intima-media thickness (cIMT), pulse wave velocity-beginning of systole (PWV-BS) and pulse wave velocity-end of systole (PWV-ES) were measured on sample images. Differences, distributive characteristics and correlation evaluation were assessed in patients (ages 18–29, 30–39, 40–49, 50–59, 60–69 and ≥70) and carotids (control group vs AS risk group).

Results

The cIMT, PWV-BS and PWV-ES increased with age; PWV-ES and cIMT showed an early significant increase in the 30–39 years group, whereas PWV-BS displayed a significant increase at 40–49 years compared with the 18- to 29-years group. Besides, PWV-ES correlated well with age compared with PWV-BS and cIMT. For carotid level, cIMT, PWV-BS and PWV-ES measurements were higher in the AS risk group compared with control. To compare the value of ufPWV and cIMT in early AS assessment, we subdivided groups into cIMT subgroups using a cut-off thickness of 0.050 cm. PWV-ES measurements were higher in the AS risk group compared with the control in the 0.040–0.050 cm (not thickened) and 0.051–0.060 cm (thickened) cIMT subgroups.

Conclusions

Carotid ufPWV measurement at PWV-ES is a novel modality for the early diagnosis and quantitative assessment of arterial stiffness associated with atherosclerotic risk.

Key Points

ufPWV technique is real-time and well repeatable for assessing carotid stiffness

ufPWV measurements increase and correlate well with age

PWV-ES is a quantitative predictor for the early assessment of AS

Keywords

Atherosclerosis Pulse wave velocity Carotid intima-media thickness Carotid arteries Arterial stiffness 

Abbreviations

AS

Atherosclerosis

CCA

Common carotid artery

cfPWV

Carotid-femoral pulse wave velocity

cIMT

Carotid intima-media thickness

DBP

Diastolic blood pressure

HDL

High-density lipoprotein

HL

Hyperlipoidaemia

HT

Hypertension

LDL

Low-density lipoprotein

LOAs

Limits of agreement

PWV

Pulse wave velocity

PWV-BS

Pulse wave velocity-beginning of systole

PWV-ES

Pulse wave velocity-end of systole

SBP

Systolic blood pressure

TC

Total cholesterol

TG

Triglyceride

ufPWV

Ultrafast pulse wave velocity

Notes

Funding

This work was supported by the Research Project of Jiangsu Province Hospital of TCM (grant number Y17048) and the Research Project of Jiangsu Province of TCM (grant number YB2015020).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Hui Huang, MD (Department of Ultrasound, Affiliated Hospital of Nanjing University of CM, Nanjing 210029, China).

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Pin Wang, PhD (Department of Endocrinology, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, Chengdu, Sichuan, China), kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

Supplementary material

330_2018_5705_MOESM1_ESM.docx (9.5 mb)
ESM 1 (DOCX 9775 kb)

References

  1. 1.
    Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M (2007) Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 115:459–467Google Scholar
  2. 2.
    Taylor AJ, Villines TC, Stanek EJ et al (2009) Extended-release niacin or ezetimibe and carotid intima-media thickness. N Engl J Med 361:2113–2122Google Scholar
  3. 3.
    Künzli N, Jerrett M, Garcia-Esteban R et al (2010) Ambient air pollution and the progression of atherosclerosis in adults. PLoS One 5:e9096Google Scholar
  4. 4.
    Hsue PY, Lo JC, Franklin A et al (2004) Progression of atherosclerosis as assessed by carotid intima-media thickness in patients with HIV infection. Circulation 109:1603–1608Google Scholar
  5. 5.
    Yamasaki Y, Katakami N, Furukado S et al (2010) Long-term effects of pioglitazone on carotid atherosclerosis in Japanese patients with type 2 diabetes without a recent history of macrovascular morbidity. J Atheroscler Thromb 17:1132–1140Google Scholar
  6. 6.
    Lorenz MW, Polak JF, Kavousi M et al (2012) Carotid intima-media thickness progression to predict cardiovascular events in the general population (the PROG-IMT collaborative project): a meta-analysis of individual participant data. Lancet 379:2053–2062Google Scholar
  7. 7.
    Stary HC, Chandler AB, Glagov S et al (1994) A definition of initial, fatty streak, and intermediate lesions of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation 89:2462–2478Google Scholar
  8. 8.
    Ben-Shlomo Y, Spears M, Boustred C et al (2014) Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol 63:636–646Google Scholar
  9. 9.
    Cavalcante JL, Lima JA, Redheuil A, Al-Mallah MH (2011) Aortic stiffness: current understanding and future directions. J Am Coll Cardiol 57:1511–1522Google Scholar
  10. 10.
    Mancia G, Fagard R, Narkiewicz K et al (2013) 2013 ESH/ESC guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 34:2159–2219Google Scholar
  11. 11.
    Laurent S, Cockcroft J, Van Bortel L et al (2006) Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 27:2588–2605Google Scholar
  12. 12.
    Van Bortel LM, Laurent S, Boutouyrie P et al (2012) Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. J Hypertens 30:445–448Google Scholar
  13. 13.
    Németh ZK, Studinger P, Kiss I et al (2011) The method of distance measurement and torso length influences the relationship of pulse wave velocity to cardiovascular mortality. Am J Hypertens 24:155–161Google Scholar
  14. 14.
    Millasseau SC, Stewart AD, Patel SJ, Redwood SR, Chowienczyk PJ (2005) Evaluation of carotid-femoral pulse wave velocity: influence of timing algorithm and heart rate. Hypertension 45:222–226Google Scholar
  15. 15.
    Reference Values for Arterial Stiffness’ Collaboration (2010) Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: establishing normal and reference values. Eur Heart J 31:2338–2350Google Scholar
  16. 16.
    Wilkinson IB, McEniery CM, Schillaci G et al (2010) ARTERY Society guidelines for validation of noninvasive haemodynamic measurement devices: part 1, arterial pulse wave velocity. Artery Res 4:34–40Google Scholar
  17. 17.
    Messas E, Pernot M, Couade M (2013) Arterial wall elasticity: state of the art and future prospects. Diagn Interv Imaging 94:561–569Google Scholar
  18. 18.
    Couade M, Pernot M, Prada C et al (2010) Quantitative assessment of arterial wall biomechanical properties using shear wave imaging. Ultrasound Med Biol 36:1662–1676Google Scholar
  19. 19.
    Couade M, Pernot M, Messas E et al (2011) Ultrafast imaging of the arterial pulse wave. IRBM 32:106–108Google Scholar
  20. 20.
    Mirault T, Pernot M, Frank M et al (2015) Carotid stiffness change over the cardiac cycle by ultrafast ultrasound imaging in healthy volunteers and vascular Ehlers-Danlos syndrome. J Hypertens 33:1890–1896Google Scholar
  21. 21.
    Stone NJ, Robinson JG, Lichtenstein AH et al (2014) 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63:2889–2934Google Scholar
  22. 22.
    Montaldo G, Tanter M, Bercoff J, Benech N, Fink M (2009) Coherent plane-wave compounding for very high frame rate ultrasonography and transient elastography. IEEE Trans Ultrason Ferroelectr Freq Control 56:489–506Google Scholar
  23. 23.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310Google Scholar
  24. 24.
    Bos D, van der Rijk MJ, Geeraedts TE et al (2012) Intracranial carotid artery atherosclerosis: prevalence and risk factors in the general population. Stroke 43:1878–1884Google Scholar
  25. 25.
    Thomas GN, Lin JW, Lam WW et al (2004) Increasing severity of cardiovascular risk factors with increasing middle cerebral artery stenotic involvement in type 2 diabetic Chinese patients with asymptomatic cerebrovascular disease. Diabetes Care 27:1121–1126Google Scholar
  26. 26.
    Naqvi TZ, Lee MS (2014) Carotid intima-media thickness and plaque in cardiovascular risk assessment. JACC Cardiovasc Imaging 7:1025–1038Google Scholar
  27. 27.
    Polak JF, Pencina MJ, O'Leary DH, D'Agostino RB (2011) Common carotid artery intima-media thickness progression as a predictor of stroke in multi-ethnic study of atherosclerosis. Stroke 42:3017–3021Google Scholar
  28. 28.
    Den Ruijter HM, Peters SA, Anderson TJ et al (2012) Common carotid intima-media thickness measurements in cardiovascular risk prediction: a meta-analysis. JAMA 308:796–803Google Scholar
  29. 29.
    Polak JF, Pencina MJ, Pencina KM, O'Donnell CJ, Wolf PA, D'Agostino RB Sr (2011) Carotid-wall intima-media thickness and cardiovascular events. N Engl J Med 365:213–221Google Scholar
  30. 30.
    Laurent S, Katsahian S, Fassot C et al (2003) Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke 34:1203–1206Google Scholar
  31. 31.
    Laurent S, Boutouyrie P, Asmar R et al (2001) Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 37:1236–1241Google Scholar
  32. 32.
    Bérard E, Bongard V, Ruidavets JB, Amar J, Ferrières J (2013) Pulse wave velocity, pulse pressure and number of carotid or femoral plaques improve prediction of cardiovascular death in a population at low risk. J Hum Hypertens 27:529–534Google Scholar
  33. 33.
    Paini A, Boutouyrie P, Calvet D, Tropeano AI, Laloux B, Laurent S (2006) Carotid and aortic stiffness: determinants of discrepancies. Hypertension 47:371–376Google Scholar
  34. 34.
    Verwoert GC, Franco OH, Hoeks AP et al (2014) Arterial stiffness and hypertension in a large population of untreated individuals: the Rotterdam Study. J Hypertens 32:1606–1612Google Scholar
  35. 35.
    Mirault T, Papadacci C, Dizier BT et al (2013) Non invasive and real time evaluation of mice aortic stiffness by ultrafast ultrasound imaging: a new tool for evaluation of preclinical vascular disease models. Eur Heart J 34:P2527Google Scholar
  36. 36.
    Hermeling E, Reesink KD, Kornmann LM, Reneman RS, Hoeks AP (2009) The dicrotic notch as alternative time-reference point to measure local pulse wave velocity in the carotid artery by means of ultrasonography. J Hypertens 27:2028–2035Google Scholar
  37. 37.
    Huang C, Su Y, Zhang H, Qian LX, Luo J (2016) Comparison of different pulse waveforms for local pulse wave velocity measurement in healthy and hypertensive common carotid arteries in vivo. Ultrasound Med Biol 42:1111–1123Google Scholar
  38. 38.
    Li X, Jiang J, Zhang H et al (2017) Measurement of carotid pulse wave velocity using ultrafast ultrasound imaging in hypertensive patients. J Med Ultrason (2001) 44:183–190Google Scholar
  39. 39.
    Goldstein BI, Carnethon MR, Matthews KA et al (2015) Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease: a scientific statement from the American Heart Association. Circulation 132:965–986Google Scholar
  40. 40.
    van Os HJ, Mulder IA, van der Schaaf IC et al (2016) Role of atherosclerosis, clot extent, and penumbra volume in headache during ischemic stroke. Neurology 87:1124–1130Google Scholar
  41. 41.
    Handa N, Matsumoto M, Maeda H et al (1990) Ultrasonic evaluation of early carotid atherosclerosis. Stroke 21:1567–1572Google Scholar
  42. 42.
    Pan FS, Yu L, Luo J et al (2018) Carotid artery stiffness assessment by ultrafast ultrasound imaging: feasibility and potential influencing factors. J Ultrasound Med.  https://doi.org/10.1002/jum.14630

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Zheng-Qiu Zhu
    • 1
  • Ling-Shan Chen
    • 2
  • Han Wang
    • 3
  • Fu-Ming Liu
    • 4
  • Yun Luan
    • 1
  • Lin-Lin Wu
    • 1
  • Niu Liu
    • 1
  • Pin Wang
    • 5
  • Hui Huang
    • 1
    Email author
  1. 1.Department of UltrasoundAffiliated Hospital of Nanjing University of CMNanjingChina
  2. 2.Department of RadiologyAffiliated Hospital of Nanjing University of CMNanjingChina
  3. 3.Department of GeratologyAffiliated Hospital of Nanjing University of CMNanjingChina
  4. 4.Department of CardiologyAffiliated Hospital of Nanjing University of CMNanjingChina
  5. 5.Department of EndocrinologySichuan Academy of Medical Science and Sichuan Provincial People’s HospitalChengduChina

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