Mylab Desk Version Downloadpdf 59
Milan Kemezy
Type 2 diabetes is one of the most common causes of cardiovascular disease as it causes arterial stiffness changes. The purpose of this study is to characterize, in vivo, carotid arterial structural and functional changes by applying radio frequency and X-strain ultrasound techniques.
Ninety-one subjects were assigned into two groups; a diabetes group and a control group. Structural and functional changes in the common carotid arterial wall were investigated by quality intima-media thickness (QIMT), quality arterial stiffness (QAS), and X-strain analysis with a Mylab Twice ultrasound instrument. The relationships among variables between the two groups were analyzed in this study.
In type 2 diabetes, the functional changes in CCA can be identified using the methods presented in this article earlier than the structural changes. Arterial stiffness values provided by QAS and X-strain analysis can be used as indicators of CCA functional lesions in patients with type 2 diabetes.
Diabetes is a major contributor to atherosclerosis of the arterial bed [1, 2]. Patients with diabetes are at a high risk of artery atherosclerosis leading to cardiovascular disease (CVD), especially coronary heart disease (CHD), which is the most common complication and the principal cause of death in type 2 diabetes patients. The carotid artery can be considered as a model to reflect conditions common to all infected arteries. Detection of structural and functional disorders of the common carotid artery (CCA) by duplex ultrasonography is most favorite method in evaluating systemic artery atherosclerosis.
Ultrasound examinations were conducted with a Mylab Twice color Doppler ultrasound diagnostic system (Esaote, Firenze, Italy), using a 5-13 MHz vascular probe LA523 with built-in quality intima-media thickness (QIMT), quality arterial stiffness (QAS), and X-strain analysis software. After each subject was placed in the supine position, the right common carotid artery (RCCA), carotid bulb, and portions of the internal carotid arteries on both sides were scanned. The region of interest (ROI) was defined as 30 mm proximal to the beginning of the dilation of the bifurcation bulb.
The CCA examination was performed by two ultrasound physicians with 10 years working experience who had received formal training in vascular screening. The physicians were blinded to any clinical information regarding the subjects.
QIMT analysis of the common carotid artery. The red line represents the radiofrequency signal tracking the leading edge of the lumen intima; the green line represents the radiofrequency signal tracking the leading edge of media adventitia interface. The IMT value and vascular diameter was calculated automatically for six cardiac cycles showed on the left side of the picture.
QAS analysis of the common carotid artery. (A) The red line represents the radiofrequency signal tracking the leading edge of the lumen intima; the green line represents the radiofrequency signal tracking the leading edge of media adventitia interface. (B) The stiffness value was calculated automatically for six cardiac cycles.
The X-strain analysis site is located 1 cm proximal to the bifurcation. Long and short axis were showed in the same measurement site The sampling sites were placed at the leading edge of the lumen intima and the leading edge of media adventitia interface at the posterior wall. The RF signal tracked both the motion of vascular intima and adventitia for at least three consecutive heart beats. The real-time images were stored and offline analysis was performed using a workstation equipped with Mylab desk analysis software (Figure 3). Depending on the view under analysis the following parameters were calculated as shown in Table 1.
X-strain analysis of the common carotid artery. Longitudinal (A) and transverse (B) views were shown in the same position of the common carotid artery. The motion of the lumen intima and the adventitia were colorized as shown in the upper side of left column. The curves of different variables by X-strain analysis were traced automatically (the right column). In the pictures, we provide velocity curves analyzed by the X-strain method.
Except that the radial strain and strain rate was output as the difference of the intima and adventitia values by the software, other parameters were output as the intima and adventitia values respectively. So variables are expressed as D (the intima and adventitia peak value difference), DT (the time of the intima and adventitia peak value difference) and TD (the time difference of the intima and adventitia peak value). Significant difference between the two group and correlations among these variables were evaluated.
The main clinical and pathological data for patients at the beginning of the study are presented in Table 2. BSA, DBP, SBP, total cholesterol, LDL cholesterol, TC and HAb1c were higher in patients with diabetes. There were no significant differences between groups with respect to the other characteristics concerned.
Correlations of significantly different parameters in the patient group. Among them, the correlations of BSA and ROT-DT, BSA and β, BSA and PWV, CS-DT and CC, CC and RSR-T, and CC and PWV had statistical significance as shown.
Besides the stiffness values acquired by QAS, X-strain techniques, a novel method based on the two-dimensional information obtained directly from the arterial wall itself both for the intima and adventitia at the same time, can give us more information about local arterial stiffness, rather than depending on luminal changes. The quantitative assessment of the regional function of the arterial wall may be based on the mobility of the intima, of the adventitia and on wall thickening. Strain and strain rate imaging provides a quantitative method for assessing the regional function of the arterial wall. The variables include the displacement, strain, and strain rate of the arterial wall movement for circumferential, longitudinal, radial, and rotation movements. Like myocardial movement, the intima and adventitial wall stretch in different sectors at the same time can be showed to us by the real-time X-strain analysis. The final arterial wall movement at that moment is decided by the multi-directional forces on both intima and adventitial wall. Unlike other strain analysis technology, X-strain analysis allows us to evaluate all of the forces at the same time and helps us to comprehensively understand the movement of the arterial wall. To our knowledge, this is the first report in the literature to assess arterial stiffness from multiple angles using the speckle tracking method.
In conclusion, the present study demonstrated that patients with diabetes have significantly increased arterial stiffness as assessed by QAS and X-strain assessment. QIMT and QAS techniques can be used to noninvasively and comprehensively assess local elastic arterial remodeling in patients with early stage diabetes.
LZ devised the study, designed the protocol, participated in fund raising, interpretation of results and prepared the manuscript draft. JKY performed all the statistical analysis. YYD participated in the study design, fund raising and corrected the final version of the manuscript. XL participated in the study design, analytical methods, interpretation of results, and data collection. JW and LX participated in data collection and interpretation of results. YLY participated in the protocol design, fund raising, analysis of results. LJY and TSC participated in the final review of the manuscript. Finally, all authors reviewed and approved the final version of the manuscript.
Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated.
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