J Cardiovasc Ultrasound.  2016 Sep;24(3):215-222. 10.4250/jcu.2016.24.3.215.

The Value of Elastic Modulus Index as a Novel Surrogate Marker for Cardiovascular Risk Stratification by Dimensional Speckle-Tracking Carotid Ultrasonography

• Yoon JH
• Cho IJ
• Chang HJ
• Sung JM
• Lee J
• Ryoo H
• Shim CY
• Hong GR
• Chung N

• KMID: 2353099
• DOI: http://doi.org/10.4250/jcu.2016.24.3.215

Abstract

BACKGROUND
Carotid intima media thickness (CIMT) and the presence of carotid plaque have been used for risk stratification of cardiovascular disease (CVD). To date, however, the association between multi-directional functional properties of carotid artery and CVD has not been fully elucidated. We sought to explore the multi-directional mechanics of the carotid artery in relation to cardiovascular risk.
METHODS
Four hundred one patients who underwent carotid ultrasound were enrolled between January 2010 and April 2013. A high risk of CVD was defined as more than 20% of 10-year risk based on the Framingham risk score. Using a speckle-tracking technique, the longitudinal and radial movements were analyzed in the B-mode images. Peak longitudinal and radial displacements, strain and strain rate were also measured. Beta stiffness and elastic modulus index were calculated from the radial measurements.
RESULTS
Of the overall sample, 13% (52) of patients comprised the high-risk group. In multivariate logistic regression, CIMT and elastic modulus index were independently associated with a high-risk of CVD {odds ratio (OR): 1.810 [95% confidence interval (CI) 1.249-2.622] and OR: 1.767 (95% CI: 1.177-2.652); p = 0.002, 0.006, respectively}. The combination of CIMT and elastic modulus index correlated with a high-risk of CVD more so than CIMT alone.
CONCLUSION
The elastic modulus index of the carotid artery might serve as a novel surrogate marker of high-risk CVD. Measurement of the multi-directional mechanics of the carotid artery using the speckle tracking technique has potential for providing further information over conventional B-mode ultrasound for stratification of CVD risk.

Keyword

Elastic modulus; Carotid artery; Cardiovascular disease

MeSH Terms

Biomarkers*
Cardiovascular Diseases
Carotid Arteries
Carotid Intima-Media Thickness
Elastic Modulus*
Humans
Logistic Models
Mechanics
Ultrasonography*
Biomarkers

Figure

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  Fig. 1 Definition of terms used for the calculation of elastic modulus index.

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  Fig. 2 Examples of carotid echocardiographic data from B-mode (left) and longitudinal strain curves of the carotid artery by speckle-tracking imaging (right) in a 45-year-old woman belonging to the non high-risk group (A) and a 48-year-old woman in the high-risk group (B). IMT: intima media thickness.

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  Fig. 3 Receiver operating characteristic (ROC) curves for CIMT (A) and elastic modulus index (B). IMT: intima media thickness, CIMT: carotid intima media thickness.

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  Fig. 4 Receiver operating characteristic (ROC) curves for CIMT, elastic modulus index and CIMT + elastic modulus index. *IMT = 0.7367, †Elastic modulus = 0.7122, ‡IMT + elastic modulus = 0.7943. IMT: intima media thickness, CIMT: carotid intima media thickness.

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