Relation of carotid artery diameter with cardiac geometry and mechanics in heart failure with preserved ejection fraction

J Am Heart Assoc. 2012 Dec;1(6):e003053. doi: 10.1161/JAHA.112.003053. Epub 2012 Dec 19.

Abstract

Background: Central artery dilation and remodeling are associated with higher heart failure and cardiovascular risks. However, data regarding carotid artery diameter from hypertension to heart failure have remained elusive. We sought to investigate this issue by examining the association between carotid artery diameter and surrogates of ventricular dysfunction.

Methods and results: Two hundred thirteen consecutive patients including 49 with heart failure and preserved ejection fraction (HFpEF), 116 with hypertension, and an additional 48 healthy participants underwent comprehensive echocardiography and tissue Doppler imaging. Ultrasonography of the common carotid arteries was performed for measurement of intima-media thickness and diameter (CCAD). Cardiac mechanics, including LV twist, were assessed by novel speckle-tracking software. A substantial graded enlargement of CCAD was observed across all 3 groups (6.8 ± 0.6, 7.7 ± 0.73, and 8.7 ± 0.95 mm for normal, hypertension, and HFpEF groups, respectively; ANOVA P<0.001) and correlated with serum brain natriuretic peptide level (R(2)=0.31, P<0.001). Multivariable models showed that CCAD was associated with increased LV mass, LV mass-to-volume ratio (β-coefficient=10.9 and 0.11, both P<0.001), reduced LV longitudinal and radial strain (β-coeffficient=0.81 and -3.1, both P<0.05), and twist (β-coefficient=-0.84, P<0.05). CCAD set at 8.07 mm as a cut-off had a 77.6% sensitivity, 82.3% specificity, and area under the receiver operating characteristic curves (AUROC) of 0.86 (95% CI 0.80 to 0.92) in discriminating HFpEF. In addition, CCAD superimposed on myocardial deformation significantly expanded AUROC (for longitudinal strain, from 0.84 to 0.90, P of ΔAUROC=0.02) in heart failure discrimination models.

Conclusions: Increased carotid artery diameter is associated with worse LV geometry, higher brain natriuretic peptide level, and reduced contractile mechanics in individuals with HFpEF.

Keywords: cardiac mechanics; carotid artery diameter; heart failure; hypertension; remodeling; strain.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carotid Intima-Media Thickness*
  • Case-Control Studies
  • Cross-Sectional Studies
  • Diastole / physiology
  • Echocardiography, Doppler
  • Female
  • Heart Failure / blood
  • Heart Failure / physiopathology*
  • Heart Ventricles / pathology
  • Hemodynamics / physiology
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Retrospective Studies
  • Stroke Volume / physiology*
  • Tomography, X-Ray Computed
  • Ventricular Dysfunction, Left*
  • Ventricular Remodeling / physiology

Substances

  • Natriuretic Peptide, Brain