Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
J Am Heart Assoc. 2012 Dec;1(6):e003053. doi: 10.1161/JAHA.112.003053. Epub 2012 Dec 19.
Central artery dilation and remodeling are associated with higher heart failure and cardiovascular risks. However, data regarding carotid artery diameter from hypertension to heart failure have remained elusive. We sought to investigate this issue by examining the association between carotid artery diameter and surrogates of ventricular dysfunction.
Two hundred thirteen consecutive patients including 49 with heart failure and preserved ejection fraction (HFpEF), 116 with hypertension, and an additional 48 healthy participants underwent comprehensive echocardiography and tissue Doppler imaging. Ultrasonography of the common carotid arteries was performed for measurement of intima-media thickness and diameter (CCAD). Cardiac mechanics, including LV twist, were assessed by novel speckle-tracking software. A substantial graded enlargement of CCAD was observed across all 3 groups (6.8 ± 0.6, 7.7 ± 0.73, and 8.7 ± 0.95 mm for normal, hypertension, and HFpEF groups, respectively; ANOVA P<0.001) and correlated with serum brain natriuretic peptide level (R(2)=0.31, P<0.001). Multivariable models showed that CCAD was associated with increased LV mass, LV mass-to-volume ratio (β-coefficient=10.9 and 0.11, both P<0.001), reduced LV longitudinal and radial strain (β-coeffficient=0.81 and -3.1, both P<0.05), and twist (β-coefficient=-0.84, P<0.05). CCAD set at 8.07 mm as a cut-off had a 77.6% sensitivity, 82.3% specificity, and area under the receiver operating characteristic curves (AUROC) of 0.86 (95% CI 0.80 to 0.92) in discriminating HFpEF. In addition, CCAD superimposed on myocardial deformation significantly expanded AUROC (for longitudinal strain, from 0.84 to 0.90, P of ΔAUROC=0.02) in heart failure discrimination models.
Increased carotid artery diameter is associated with worse LV geometry, higher brain natriuretic peptide level, and reduced contractile mechanics in individuals with HFpEF.
颈总动脉扩张和重塑与心力衰竭和心血管风险增加有关。然而，从高血压到心力衰竭的颈动脉直径数据仍难以捉摸。我们通过检查颈动脉直径与心室功能障碍替代标志物之间的关系来研究这个问题。
连续纳入 213 例患者，包括 49 例心力衰竭和射血分数保留（HFpEF）患者、116 例高血压患者和另外 48 例健康参与者，进行全面超声心动图和组织多普勒成像检查。对颈总动脉进行超声检查，测量内膜中层厚度和直径（CCAD）。使用新的斑点追踪软件评估心脏力学，包括左心室扭转。在所有 3 组中均观察到 CCAD 明显分级增大（分别为正常组 6.8±0.6mm、高血压组 7.7±0.73mm 和 HFpEF 组 8.7±0.95mm；方差分析 P<0.001），并与血清脑钠肽水平相关（R（2）=0.31，P<0.001）。多变量模型显示，CCAD 与左心室质量增加、左心室质量与容积比（β系数=10.9 和 0.11，均 P<0.001）、左心室纵向和径向应变降低（β系数=0.81 和-3.1，均 P<0.05）和扭转（β系数=-0.84，P<0.05）相关。将 CCAD 设定为 8.07mm 作为截断值，在 HFpEF 鉴别中具有 77.6%的敏感性、82.3%的特异性和 0.86（95%CI 0.80 至 0.92）的受试者工作特征曲线下面积（AUROC）。此外，在心力衰竭鉴别模型中，心肌变形叠加的 CCAD 显著扩大了 AUROC（纵向应变从 0.84 增加到 0.90，P 值为ΔAUROC=0.02）。
在 HFpEF 个体中，颈总动脉直径增加与左心室几何形状恶化、脑钠肽水平升高和收缩力学降低有关。
