Selamet Tierney Elif Seda, Gauvreau Kimberlee, Jaff Michael R, Gal Dana, Nourse Susan E, Trevey Shari, O'Neill Stephen, Baker Annette, Newburger Jane W, Colan Steven D
Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California.
Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
J Am Soc Echocardiogr. 2015 Mar;28(3):309-16. doi: 10.1016/j.echo.2014.10.004. Epub 2014 Nov 20.
Carotid artery intima-media thickness (CIMT), a marker of atherosclerosis, is increased in youth at risk for future cardiovascular disease. Some pediatric studies have used CIMT as a primary outcome in clinical trials, yet data are limited on the standardization of methodology in children. The goal of this study was to evaluate reproducibility of CIMT measurements using two different measurement techniques.
Carotid artery ultrasound studies of children and adolescents obtained as a component of a research study in Kawasaki syndrome were retrospectively analyzed. The CIMTs of both common carotid arteries (CCAs) were measured by one of two sonographers at the time in the cardiac cycle when resolution subjectively was determined to be optimal (Opt-CIMT). These sonographers blindly remeasured a random sample of studies of their own and each other's, using the same method. Another observer made CIMT measurements using exclusively frames on the R wave (R-CIMT). A fourth observer independently measured a random sample of studies twice with the R-CIMT method.
Carotid artery images from 184 subjects (mean age, 14.7 ± 2.2 years) were analyzed. The intraclass correlation coefficient for interobserver variability was 0.86 (95% confidence interval [CI], 0.69-0.94) compared with 0.85 (95% CI, 0.65-0.93) for the right and 0.86 (95% CI, 0.67-0.94) versus 0.95 (95% CI, 0.87-0.98) for the left CCA for Opt-CIMT and R-CIMT, respectively. R-CIMT was significantly thicker than Opt-CIMT (right CCA, 0.439 ± 0.030 vs 0.428 ± 0.024 mm, P < .001; left CCA, 0.446 ± 0.030 vs 0.434 ± 0.025 mm, P < .001).
Pediatric CIMT measurements have excellent reproducibility when the same methodology is applied but vary significantly throughout the cardiac cycle. This report highlights the need to standardize CIMT measurements in the youth and supports the use of electrocardiographic timing, as recommended in adults, in pediatric longitudinal studies.
颈动脉内膜中层厚度（CIMT）是动脉粥样硬化的一个标志物，在未来有心血管疾病风险的年轻人中会增加。一些儿科研究已将CIMT用作临床试验的主要结局指标，但关于儿童测量方法标准化的数据有限。本研究的目的是评估使用两种不同测量技术进行CIMT测量的可重复性。
回顾性分析作为川崎综合征一项研究组成部分所获得的儿童和青少年的颈动脉超声研究。在心动周期中主观判定分辨率最佳的时间点，由两名超声检查人员之一测量双侧颈总动脉（CCA）的CIMT（最佳CIMT）。这些超声检查人员使用相同方法对他们自己和彼此的研究随机样本进行盲法重新测量。另一名观察者仅使用R波上的帧测量CIMT（R波CIMT）。第四名观察者使用R波CIMT方法对研究随机样本独立测量两次。
分析了184名受试者（平均年龄14.7±2.2岁）的颈动脉图像。观察者间变异性的组内相关系数为0.86（95%置信区间[CI]，0.69 - 0.94），右侧CCA的最佳CIMT和R波CIMT分别为0.85（95%CI，0.65 - 0.93）和0.86（95%CI，0.67 - 0.94），左侧CCA分别为0.86（95%CI，0.67 - 0.94）和0.95（95%CI，0.87 - 0.98）。R波CIMT显著厚于最佳CIMT（右侧CCA，0.439±0.030对0.428±0.024mm，P <.001；左侧CCA，0.446±0.030对0.434±0.025mm，P <.001）。
当应用相同方法时，儿科CIMT测量具有良好的可重复性，但在整个心动周期中差异显著。本报告强调了在青少年中标准化CIMT测量的必要性，并支持在儿科纵向研究中如成人所推荐的那样使用心电图计时。
