Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Laboratory, The University of Tokyo, Tokyo, Japan.
Atherosclerosis. 2020 Jul;305:42-49. doi: 10.1016/j.atherosclerosis.2020.05.019. Epub 2020 Jun 15.
Although carotid intima-media thickness (IMT) is an established marker of atherosclerosis and carries independent risk for cardiovascular disease, its possible association with subclinical cardiac dysfunction has not been extensively evaluated. Left ventricular global longitudinal strain (LVGLS) and peak left atrial longitudinal systolic strain (PALS) can detect subclinical left heart dysfunction. This study aimed to investigate the association between carotid IMT and subclinical left heart dysfunction in a sample of the general population without overt cardiac disease.
We examined 1161 participants who underwent extensive cardiovascular examination. Ultrasonography of common carotid artery was performed for the measurement of maximal carotid IMT. LVGLS and PALS were assessed by 2-dimensional speckle-tracking echocardiography.
Mean age was 62 ± 12 years, and 56% were male. The prevalence of abnormal LVGLS (>-18.6%) and PALS (<31.4%) was greatest in the upper quartile of carotid IMT (both p < 0.001). In multivariable analyses, carotid IMT was associated with abnormal LVGLS (adjusted odds ratio = 1.33 per 1SD increase of IMT, p = 0.003) as well as PALS (adjusted odds ratio = 1.33 per 1SD increase of IMT, p = 0.005) independent of traditional cardiovascular risk factors, echocardiographic parameters including LV ejection fraction, LV mass index and diastolic dysfunction, and pertinent laboratory parameters. The independent association between carotid IMT and PALS persisted even after adjustment for LVGLS.
Participants with increased IMT had significantly impaired LV and LA function in an unselected community-based cohort. This association may be involved in the higher incidence of cardiovascular disease in individuals with increased carotid IMT.
尽管颈动脉内膜-中层厚度（IMT）是动脉粥样硬化的既定标志物，并且与心血管疾病的独立风险相关，但尚未广泛评估其与亚临床左心功能障碍的可能关联。左心室整体纵向应变（LVGLS）和左心房纵向收缩峰值应变（PALS）可检测亚临床左心功能障碍。本研究旨在调查在无明显心脏疾病的一般人群样本中，颈动脉 IMT 与亚临床左心功能障碍之间的关联。
我们检查了 1161 名接受广泛心血管检查的参与者。对颈总动脉进行超声检查，以测量最大颈动脉 IMT。通过二维斑点追踪超声心动图评估 LVGLS 和 PALS。
平均年龄为 62±12 岁，56%为男性。颈动脉 IMT 四分位间距最高组的异常 LVGLS（>-18.6%）和 PALS（<31.4%）的患病率最高（两者均 p<0.001）。在多变量分析中，颈动脉 IMT 与异常 LVGLS（IMT 每增加 1SD，调整后的优势比为 1.33，p=0.003）以及 PALS（IMT 每增加 1SD，调整后的优势比为 1.33，p=0.005）相关，独立于传统心血管危险因素、超声心动图参数（包括左心室射血分数、左心室质量指数和舒张功能障碍）和相关实验室参数。颈动脉 IMT 与 PALS 之间的独立关联在调整 LVGLS 后仍然存在。
在未选择的基于社区的队列中，IMT 增加的参与者的 LV 和 LA 功能明显受损。这种关联可能与 IMT 增加个体中更高的心血管疾病发生率有关。
