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Changes in carotid intima-media thickness during the cardiac cycle: the multi-ethnic study of atherosclerosis
Joseph F Polak1, Craig Johnson, Anita Harrington
1Department of Radiology, Tufts University School of Medicine, Boston, MA (J.F.P., A.H.).
Insights
Carotid intima-media thickness (IMT) changes during the cardiac cycle, impacting cardiovascular disease risk assessment. This variation, influenced by ethnicity and pulse pressure, necessitates careful consideration of measurement timing for accurate risk stratification.
Area of Science:
- Cardiovascular Imaging and Diagnostics
- Vascular Biology
- Public Health and Epidemiology
Background:
- Common carotid artery intima-media thickness (IMT) is a key indicator of subclinical cardiovascular disease.
- IMT exhibits dynamic changes throughout the cardiac cycle, but the extent and clinical significance remain understudied.
Purpose of the Study:
- To investigate the magnitude of cardiac cycle-induced changes in carotid IMT.
- To determine the association of these IMT variations with cardiovascular risk factors.
- To assess the impact of measurement timing on cardiovascular risk classification.
Main Methods:
- Utilized data from 5633 Multi-Ethnic Study of Atherosclerosis (MESA) participants.
- Measured far-wall IMT of the right common carotid artery at end diastole and peak systole.
- Employed multivariable regression models to analyze associations between IMT, cardiac cycle changes, and risk factors.
Main Results:
- Average change in carotid IMT during the cardiac cycle was 0.041 mm.
- IMT change was significantly associated with ethnicity and pulse pressure, but not age or sex.
- Using peak-systolic IMT reference values classified 31.3% more individuals into the high-risk quartile compared to end-diastolic measurements.
Conclusions:
- Carotid IMT demonstrates significant, measurable changes during the cardiac cycle.
- These dynamic IMT variations influence cardiovascular risk assessment accuracy.
- Published normative data based on peak-systolic IMT may lead to overestimation of cardiovascular risk compared to end-diastolic measurements.
Background:
Common carotid artery intima-media thickness (IMT), a measure of subclinical cardiovascular disease, changes during the cardiac cycle. The magnitude of this effect and its implications have not been well studied.
Methods And Results:
Far-wall IMT measurements of the right common carotid artery were measured at end diastole and peak systole in 5633 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA). Multivariable regression models were generated with end-diastolic IMT, peak-systolic IMT, and change in IMT during the cardiac cycle as dependent variables and traditional cardiovascular risk factors as independent variables. The average age of our population was 61.9 (45 to 84) years. Average change in carotid IMT during the cardiac cycle was 0.041 mm (95% confidence interval: 0.039 to 0.042 mm), with a mean IMT of 0.68 mm. End-diastolic IMT and peak-systolic IMT were similarly associated with risk factors. In a fully adjusted model, change in carotid IMT during the cardiac cycle was associated with ethnicity and pulse pressure (P=0.001) and not age, sex, or other risk factors. Chinese and Hispanics had less of a change in IMT than did non-Hispanic whites. With peak-systolic IMT reference values used as normative data, 31.3% more individuals were classified as being in the upper quartile of IMT and at high risk for cardiovascular disease than would be expected when IMT is measured at end diastole.
Conclusions:
Measurable differences in IMT are seen during the cardiac cycle. This affects the interpretation of IMT measurements used for cardiovascular risk assessment, given published normative data with IMT measured at peak systole.
Clinical Trial Registration:
URL: www.ClinicalTrials.gov. Unique identifier: NCT00063440. (J Am Heart Assoc. 2012;1:e001420 doi: 10.1161/JAHA.112.001420.).
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