Lee Sang-Eun, Lee Jinyong, Yoo Tae-Hyun, Cho In-Jeong, Chang Hyuk-Jae
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
J Cardiovasc Imaging. 2018 Sep;26(3):155-164. doi: 10.4250/jcvi.2018.26.e16. Epub 2018 Sep 17.
Arterial stiffening is a major contributing factor in the development of cardiovascular disease in patients with end-stage renal disease (ESRD). However, there is no gold standard for evaluating arterial stiffness. This study aimed to evaluate the newly developed speckle-tracking carotid strain imaging method in assessing arterial stiffness in patients with ESRD.
In total, 85 patients with normal renal function (controls) and 36 with ESRD were enrolled in this single-center study. Carotid B-mode ultrasonography was performed for all patients. Arterial stiffness indices and strain parameters of the common carotid arteries were analyzed. Values were compared between the groups, and multivariate linear regression analysis was performed to assess the impact of ESRD on carotid strain.
There were no differences in the intima-media thickness, β stiffness index, and arterial compliance, but arterial distensibility was lower, and the elastic modulus and pulse wave velocity β (PWV) were higher among patients with ESRD (all p < 0.05), whether assessed in the longitudinal or transverse plane. Both longitudinal and transverse strain rates were reduced in patients with ESRD (all p < 0.05). In multivariate analyses, ESRD independently reduced both transverse radial strain and strain rate (all p < 0.05), and the transverse circumferential strain and strain rate (p < 0.05). However, all conventional aortic stiffness indices and longitudinal strain parameters were not associated with ESRD.
Speckle-tracking carotid strain ultrasonography was successfully performed in both normal subjects and patients with ESRD. Multidirectional carotid strain analyses may provide more value than conventional aortic stiffness indices for risk stratification in patients with ESRD.
动脉僵硬度增加是终末期肾病（ESRD）患者心血管疾病发生发展的主要促成因素。然而，目前尚无评估动脉僵硬度的金标准。本研究旨在评估新开发的斑点追踪颈动脉应变成像方法在评估ESRD患者动脉僵硬度方面的作用。
本单中心研究共纳入85例肾功能正常的患者（对照组）和36例ESRD患者。对所有患者均进行了颈动脉B型超声检查。分析了颈总动脉的动脉僵硬度指数和应变参数。比较了两组间的数值，并进行多变量线性回归分析以评估ESRD对颈动脉应变的影响。
内膜中层厚度、β僵硬度指数和动脉顺应性在两组间无差异，但ESRD患者的动脉扩张性较低，弹性模量和脉搏波速度β（PWV）较高（所有p<0.05），无论在纵向还是横向平面评估。ESRD患者的纵向和横向应变率均降低（所有p<0.05）。在多变量分析中，ESRD独立降低横向径向应变和应变率（所有p<0.05），以及横向圆周应变和应变率（p<0.05）。然而，所有传统的主动脉僵硬度指数和纵向应变参数均与ESRD无关。
斑点追踪颈动脉应变超声检查在正常受试者和ESRD患者中均成功实施。多方向颈动脉应变分析对于ESRD患者的风险分层可能比传统的主动脉僵硬度指数更有价值。
