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Updated: May 7, 2026
Ultrasonic Assessment of Myocardial Microstructure
Published on: January 14, 2014
Association between carotid sublayers thickness and cardiac alterations in dialysis patients
Demétrio C S Vieira1, Agnes N Santos1, Vinicius C Ribeiro1
1Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, SP, Brazil.
Insights
In hemodialysis patients, carotid intima (cIT) and its ratio to the medial layer (cIT/cMT) are more strongly linked to left ventricular hypertrophy (LVH) than overall carotid intima-media thickness (cIMT). These findings suggest cIT and cIT/cMT may serve as novel cardiovascular risk markers.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Vascular Biology
Background:
- Left ventricular hypertrophy (LVH) and dysfunction increase cardiovascular risk in hemodialysis (HD) patients.
- Carotid intima-media thickness (cIMT) is a marker of atherosclerosis, but its sublayers, intimal (cIT) and medial (cMT), may offer deeper insights into LV remodeling.
- Understanding the relationship between carotid wall sublayers and LV alterations is crucial for risk stratification in HD patients.
Purpose of the Study:
- To investigate the association between carotid wall sublayers (cIT, cMT, cIT/cMT ratio) and left ventricular (LV) alterations in HD patients.
- To determine if cIT and cMT provide more specific information on LV remodeling compared to cIMT.
- To identify potential novel markers for cardiovascular risk in the HD population.
Main Methods:
- A cross-sectional study involving 102 HD patients.
- High-resolution ultrasound was used to assess cIMT, cIT, cMT, cIT/cMT ratio, and carotid plaques.
- Echocardiography evaluated LVH, LV geometric patterns, diastolic dysfunction (E/e' > 14), and systolic dysfunction (GLS > -16% or LVEF < 50%).
Main Results:
- LVH was significantly associated with cIT (OR 1.73 [1.13-2.67]), cIT/cMT ratio (OR 1.24 [1.04-1.49]), and cIMT (OR 1.41 [1.03-1.93]).
- Eccentric LVH showed associations with cIT (OR 1.64 [1.06-2.54]) and cIT/cMT ratio (OR 1.25 [1.03-1.51]).
- Diastolic and systolic LV dysfunction parameters were not independently associated with any carotid parameter.
Conclusions:
- The intimal layer (cIT) and cIT/cMT ratio are more closely associated with LVH and eccentric LVH in HD patients than cIMT or cMT.
- These carotid sublayer parameters may represent novel and more specific markers of cardiovascular risk in HD patients.
- Further research is warranted to validate these findings and explore their clinical utility.
Background:
Left ventricular (LV) hypertrophy (LVH) and dysfunction are key contributors to the increased cardiovascular risk and are related to increased carotid intima-media thickness (cIMT) in hemodialysis (HD) patients. Although cIMT is considered a marker of atherosclerosis, examining its components - the intimal layer (cIT, associated with atherosclerosis) and the medial layer (cMT, linked to arteriosclerosis) - may provide deeper insights into the mechanisms of its association with LV remodeling. This study aimed to evaluate the relationship between carotid wall sublayers and LV alterations in HD patients.
Methods:
This cross-sectional study evaluated 102 HD patients who underwent high-resolution ultrasound to evaluate cIMT, cIT, cMT, cIT/cMT ratio, and carotid plaques. LVH, LV geometric patterns, and LV diastolic dysfunction (E/e' > 14) and systolic dysfunction (global longitudinal strain [GLS] > -16% or LV ejection fraction [LVEF] < 50%) were evaluated using echocardiography.
Results:
The studied sample had age = 57 ± 15 years, 59% males and median HD vintage = 17 [2, 36] months. Multivariable logistic regression analyses showed that LVH was associated with cIT (OR [95% CI] = 1.73 [1.13-2.67], p = .012), cIT/cMT ratio (OR [95% CI] = 1.24 [1.04-1.49], p = .015) and cIMT (OR [95% CI] = 1.41 [1.03-1.93], p = .031). Regarding LV geometric patterns, results of adjusted analyses showed that eccentric LVH was associated with cIT (OR [95% CI] = 1.64 [1.06-2.54], p = .027) and cIT/cMT ratio (OR [95% CI] = 1.25 [1.03-1.51]; p = .023). Conversely, E/e' > 14, GLS > -16% and LVEF < 50% showed no independent association with any carotid parameter.
Conclusions:
cIT and cIT/cMT ratio were more closely associated with LVH and eccentric LVH than cIMT or cMT in HD patients, suggesting they may be potential novel markers of cardiovascular risk in this population.
