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Plasencia Martínez J, García Santos J. Es la medida ecográfica manual del grosor íntima-media carotídeo un biomarcador cardiovascular reproducible? RADIOLOGIA 2017; 59:478-486. [DOI: 10.1016/j.rx.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/09/2017] [Accepted: 07/10/2017] [Indexed: 01/22/2023]
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Meiburger KM, Molinari F, Wong J, Aguilar L, Gallo D, Steinman DA, Morbiducci U. Validation of the Carotid Intima-Media Thickness Variability: Can Manual Segmentations Be Trusted as Ground Truth? ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1598-1611. [PMID: 27072077 DOI: 10.1016/j.ultrasmedbio.2016.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 01/15/2016] [Accepted: 02/08/2016] [Indexed: 06/05/2023]
Abstract
The common carotid artery intima-media thickness (IMT) is widely accepted and used as an indicator of atherosclerosis. Recent studies, however, have found that the irregularity of the IMT along the carotid artery wall has a stronger correlation with atherosclerosis than the IMT itself. We set out to validate IMT variability (IMTV), a parameter defined to assess IMT irregularities along the wall. In particular, we analyzed whether or not manual segmentations of the lumen-intima and media-adventitia can be considered reliable in calculation of the IMTV parameter. To do this, we used a total of 60 simulated ultrasound images with a priori IMT and IMTV values. The images, simulated using the Fast And Mechanistic Ultrasound Simulation software, presented five different morphologies, four nominal IMT values and three different levels of variability along the carotid artery wall (no variability, small variability and large variability). Three experts traced the lumen-intima (LI) and media-adventitia (MA) profiles, and two automated algorithms were employed to obtain the LI and MA profiles. One expert also re-traced the LI and MA profiles to test intra-reader variability. The average IMTV measurements of the profiles used to simulate the longitudinal B-mode images were 0.002 ± 0.002, 0.149 ± 0.035 and 0.286 ± 0.068 mm for the cases of no variability, small variability and large variability, respectively. The IMTV measurements of one of the automated algorithms were statistically similar (p > 0.05, Wilcoxon signed rank) when considering small and large variability, but non-significant when considering no variability (p < 0.05, Wilcoxon signed rank). The second automated algorithm resulted in statistically similar values in the small variability case. Two readers' manual tracings, however, produced IMTV measurements with a statistically significant difference considering all three variability levels, whereas the third reader found a statistically significant difference in both the no variability and large variability cases. Moreover, the error range between the reader and automatic IMTV values was approximately 0.15 mm, which is on the same order of small IMTV values, indicating that manual and automatic IMTV readings should be not used interchangeably in clinical practice. On the basis of our findings, we conclude that expert manual tracings should not be considered reliable in IMTV measurement and, therefore, should not be trusted as ground truth. On the other hand, our automated algorithm was found to be more reliable, indicating how automated techniques could therefore foster analysis of the carotid artery intima-media thickness irregularity.
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Affiliation(s)
- Kristen M Meiburger
- Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Filippo Molinari
- Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy.
| | - Justin Wong
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Luis Aguilar
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Diego Gallo
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - David A Steinman
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Umberto Morbiducci
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
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Hansen K, Östling G, Persson M, Nilsson PM, Melander O, Engström G, Hedblad B, Rosvall M. The effect of smoking on carotid intima-media thickness progression rate and rate of lumen diameter reduction. Eur J Intern Med 2016; 28:74-9. [PMID: 26548715 DOI: 10.1016/j.ejim.2015.10.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/15/2015] [Accepted: 10/20/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of the study was to investigate the long-term associations between smoking habits, environmental tobacco smoke exposure (ETS), carotid intima-media thickness (IMT) progression rate, and rate of lumen diameter reduction in the carotid artery during a 16-year follow-up. Another objective was to investigate if an effect of smoking on progression rate could be explained by increased low grade inflammation. METHODS The study population included 2992 middle-aged men and women in the 1991-1994 (baseline) and the 2007-2012 (re-examination) investigation of the Malmö Diet and Cancer Study cardiovascular cohort. Associations between smoking, progression of carotid IMT and lumen diameter reduction due to plaque protrusion were assessed by linear regression. RESULTS IMT progression rates and rate of lumen diameter reduction increased from never smokers with no ETS through former, moderate and heavy smokers, even after adjustment for traditional risk factors (e.g., differences in yearly progression rates (mm/year) of maximal IMT in the carotid bifurcation compared to never smokers; former smokers 0.0074 (95% CI: 0.0018-0.0129), moderate smokers 0.0106 (95% CI: 0.0038-0.0175), and heavy smokers 0.0146 (95% CI: 0.0061-0.0230)). Former smokers showed distinct lowering of progression rates after more than five years since smoking cessation. Smoking and former smoking was associated with increased low grade inflammation, however, the effect of smoking on atherosclerotic progression rate remained fairly unchanged after such adjustment. CONCLUSION The effect of smoking and former smoking on carotid IMT progression rates and change in lumen reduction due to plaque protrusion could not be explained by differences in traditional risk factors or low grade inflammation.
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Affiliation(s)
- Kristina Hansen
- Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden.
| | - Gerd Östling
- Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden.
| | - Margaretha Persson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden.
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden.
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden.
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden.
| | - Bo Hedblad
- Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden.
| | - Maria Rosvall
- Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden.
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Davidson MH, Tomassini JE, Jensen E, Neff D, Polis AB, Tershakovec AM. Changing characteristics of statin-related cIMT trials from 1988 to 2006. Atherosclerosis 2016; 246:121-9. [PMID: 26773471 DOI: 10.1016/j.atherosclerosis.2015.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 11/16/2015] [Accepted: 11/19/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Changes in cIMT have not been consistently correlated with cardiovascular risk reduction in clinical studies. The variability of carotid intima media thickness (cIMT) changes in published statin LDL-C-lowering studies in relation to various baseline and study characteristics was assessed. METHODS This was an exploratory analysis of study-level data pooled from statin-treatment arms of 13 studies conducted during 1988-2006. Baseline mean common carotid artery (CCA)/cIMT, maximum mean CCA/cIMT and LDL-C levels, and annualized cIMT changes were estimated for the overall studies, those conducted before/after 2000, and in risk-based subgroups. Potential relationships between prespecified covariates and cIMT changes were assessed. RESULTS Baseline mean CCA/cIMT and LDL-C levels were higher in the combined studies conducted before year 2000 (0.8521 mm) than after 2000 (0.7458 mm), and somewhat higher in study populations of patients with coronary heart disease risk and those with greater LDL-C reductions. Mean CCA/cIMT changes were also larger for the studies conducted before 2000 (-0.0119 mm/year) than after 2000 (-0.0013 mm/year). Notably, studies conducted before 2000 were of longer duration (≥ 2 years) than after 2000 (<2 years). Heterogeneity in cIMT change was attributed to baseline and study-design characteristics. Longer study duration and greater LDL-C reductions were significantly related to larger annualized cIMT changes. Maximum cIMT results were similar. CONCLUSION Baseline cIMT and LDL-C levels were lower, and cIMT changes were smaller in statin cIMT trials conducted after 2000 than those before 2000. These trends are consistent with increased treatment and control of high LDL-C levels over recent years in clinical practice, and may influence the results of cIMT studies.
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Affiliation(s)
- Michael H Davidson
- Preventive Cardiology, The University of Chicago Pritzker School of Medicine, 515 North State Street Suite 2700, Chicago, IL 60610, USA.
| | - Joanne E Tomassini
- Global Clinical Development, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA.
| | - Erin Jensen
- Global Clinical Development, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA.
| | - David Neff
- Global Clinical Development, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA.
| | - Adam B Polis
- Global Clinical Development, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA.
| | - Andrew M Tershakovec
- Global Clinical Development, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA.
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Catapano AL, Farnier M, Foody JM, Toth PP, Tomassini JE, Brudi P, Tershakovec AM. Combination therapy in dyslipidemia: Where are we now? Atherosclerosis 2014; 237:319-35. [DOI: 10.1016/j.atherosclerosis.2014.09.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/08/2014] [Accepted: 09/08/2014] [Indexed: 01/06/2023]
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Ankle–Brachial Index and Its Link to Automated Carotid Ultrasound Measurement of Intima–Media Thickness Variability in 500 Japanese Coronary Artery Disease Patients. Curr Atheroscler Rep 2014; 16:393. [DOI: 10.1007/s11883-013-0393-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Saba L, Meiburger KM, Molinari F, Ledda G, Anzidei M, Acharya UR, Zeng G, Shafique S, Nicolaides A, Suri JS. Carotid IMT variability (IMTV) and its validation in symptomatic versus asymptomatic Italian population: can this be a useful index for studying symptomaticity? Echocardiography 2012; 29:1111-9. [PMID: 22748012 DOI: 10.1111/j.1540-8175.2012.01763.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The carotid intima-media thickness (IMT) is a validated marker of cerebrovascular disease risk. This paper presents a new parameter, the IMT variability (IMTV), and compares it between symptomatic and asymptomatic patients taken from a cohort of Italian population. One hundred forty-two patients were analyzed (age 59 ± 112 years, 59% males), 42 of these patients suffered from TIA or minor stroke. The lumen-intima (LI) and media-adventitia (MA) interfaces of the far wall were manually traced by a Reader. We also used a computer-based automated system (called AutoEdge) to obtain the LI/MA interfaces. The LI/MA interfaces were used to measure the IMT and the IMTV along the distal wall of the common carotid artery. Wilcoxon and Pearson correlation analyses were performed. The agreement between the Reader's IMT and the AutoEdge IMT values was 98.7% for the symptomatic (0.83 ± 0.44 mm for Reader, 0.82 ± 0.35 mm for AutoEdge) and 94.9% for the asymptomatic patients (0.78 ± 0.45 mm for Reader, 0.74 ± 0.30 mm for AutoEdge). Correlation was 65% for symptomatic and 68% for asymptomatic patients, respectively. The IMT measured using AutoEdge was 1.2% lower compared to manual measurements in symptomatic population, while 5.12% lower in asymptomatic. The IMTV was 11% higher in symptomatic patients compared to asymptomatic when using manual delineations, 8% higher when using AutoEdge. There was no statistical difference between the manual and automated IMTV measurements (Wilcoxon signed rank, P > 0.7). We conclude that the IMT and IMTV values were very similar between Reader and AutoEdge software when studying symptomatic and asymptomatic patients in Italian population.
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Affiliation(s)
- Luca Saba
- Department of Radiology, A.U.O. Cagliari, Cagliari, Italy
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