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颈动脉壁弹性成像评估宫内生长受限继发的中期血管功能障碍:可行性及与标准化内膜中层厚度的比较

Carotid wall elastography to assess midterm vascular dysfunction secondary to intrauterine growth restriction: feasibility and comparison with standardized intima-media thickness.

作者信息

Maurice Roch L, Vaujois Laurence, Dahdah Nagib, Chibab Najat, Maurice Anika, Nuyt Anne-Monique, Lévy Émile, Bigras Jean-Luc

机构信息

Service de Cardiologie, Centre Hospitalier Universitaire Sainte-Justine (CHUSJ), Université de Montréal, Montréal, Canada; Centre de Recherche, Centre Hospitalier Universitaire Sainte-Justine (CRCHUSJ), Université de Montréal, Montréal, Canada; Centre de Recherche, Centre Hospitalier de l'Université de Montréal (CRCHUM), Université de Montréal, Montréal, Canada; Université de Lyon, CREATIS; CNRS UMR5220; Inserm U1044; INSA-Lyon; Université Lyon 1, France.

Service de Cardiologie, Centre Hospitalier Universitaire Sainte-Justine (CHUSJ), Université de Montréal, Montréal, Canada.

出版信息

Ultrasound Med Biol. 2014 May;40(5):864-70. doi: 10.1016/j.ultrasmedbio.2013.11.013. Epub 2014 Feb 2.

Abstract

Several studies have suggested that intrauterine growth restriction (IUGR) increases the risk of cardiovascular disease and early atherosclerosis. Early detection of arteriopathy is essential to early intervention. Although arterial intima-media thickness (IMT) is considered an index of subclinical atherosclerosis in the adult, its validity in pediatric patients may be limited. We have recently introduced a novel imaging-based biomarker (ImBioMark) to assess intrinsic mechanical features of the arterial wall from B-mode ultrasound data. The aim of the work described here was to evaluate the potential of ImBioMark in investigation of cardiovascular health status at the level of the common carotid artery (CCA) in adolescents born after IUGR. We also compared ImBioMark results with automated IMT measurements, a well-established biomarker used in clinical practice and research. The potential sequelae of IUGR on the CCA were examined in a group of adolescents in comparison with healthy controls. Patients with IUGR (n = 7) were 13.85 ± 0.46 y old; the healthy controls (n = 7) were 14.58 ± 0.80 y old (p = 0.058). Cine loops of the CCA B-mode data were digitally recorded, and the arterial elastic modulus was estimated a posteriori with ImBioMark. IMT of the CCA was automatically calculated using QLAB software (Philips, Andover, MA, USA). All patients had been evaluated in utero in our fetal echocardiographic laboratory. ImBioMark detected a significant increase in CCA stiffness in patients with IUGR as compared with healthy controls: elastic modulus = 90.74 ± 11.86 versus 61.30 ± 15.94 kPa, respectively (p = 0.002). There was, however, no significant difference between patients with IUGR and controls in IMT (0.483 ± 0.067 versus 0.476 ± 0.051 mm, respectively, p = 0.831). The impact of IUGR on CCA wall dynamics was confirmed by ImBioMark. The apparent limitation of IMT measurement in this cohort may be the result of geometric arterial changes, that is, the expected thickening, below the level of detection at this age. As early detection of vascular modulation is essential to early intervention in a population at risk, we now intend to extend ImBioMark to investigate larger pathologic cohorts with various degrees of arteriopathy.

摘要

多项研究表明,宫内生长受限(IUGR)会增加心血管疾病和早期动脉粥样硬化的风险。早期发现动脉病变对于早期干预至关重要。尽管动脉内膜中层厚度(IMT)在成年人中被视为亚临床动脉粥样硬化的指标,但其在儿科患者中的有效性可能有限。我们最近引入了一种基于成像的新型生物标志物(ImBioMark),用于从B型超声数据评估动脉壁的内在机械特征。本文所述工作的目的是评估ImBioMark在研究IUGR后出生的青少年颈总动脉(CCA)水平心血管健康状况方面的潜力。我们还将ImBioMark的结果与自动IMT测量结果进行了比较,自动IMT测量是临床实践和研究中常用的一种成熟生物标志物。与健康对照组相比,对一组青少年的CCA上IUGR的潜在后遗症进行了检查。IUGR患者(n = 7)年龄为13.85±0.46岁;健康对照组(n = 7)年龄为14.58±0.80岁(p = 0.058)。对CCA B型数据的电影环进行数字记录,并使用ImBioMark事后估计动脉弹性模量。使用QLAB软件(美国马萨诸塞州安多弗市的飞利浦公司)自动计算CCA的IMT。所有患者均在我们的胎儿超声心动图实验室进行了宫内评估。与健康对照组相比,ImBioMark检测到IUGR患者的CCA僵硬度显著增加:弹性模量分别为9

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