This Article Figures Only Full Text Full Text (PDF) View Related Cardiosource Journal Scan Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Skilton, M. R. Articles by Bonnet, F. Search for Related Content PubMed Articles by Skilton, M. R. Articles by Bonnet, F. Related Collections Related Article

Noninvasive Measurement of Carotid Extra-Media Thickness

Associations With Cardiovascular Risk Factors and Intima-Media Thickness

Michael R. Skilton, PhD^_*,,_*, André Sérusclat, MD, Arun Harrish A.U. Sethu, BMedSci, Sophie Brun, MD, Sophie Bernard, MD^,¶, Beverley Balkau, PhD^,||, Philippe Moulin, MD, PhD^,¶, Fabrice Bonnet, MD, PhD^_*,#

^_* Centre de Recherche en Nutrition Humaine Rhône-Alpes (CRNH-RA), Université Claude Bernard Lyon 1, Lyon, France
Baker IDI Heart & Diabetes Institute, Melbourne, Australia
Department of Endocrinology, Cardiovascular Hospital, Bron, France
Faculty of Medicine, University of Melbourne, Melbourne, Australia
^¶ INSERM U870, Université Claude Bernard Lyon 1 & Hospices Civils de Lyon, Lyon, France
^|| INSERM U780, Epidemiological and Statistical Research, Villejuif, France
^# Department of Medicine, Endocrinology Unit, CHU Rennes, Université Rennes 1, Rennes, France

^_* Reprint requests and correspondence: Dr. Michael R. Skilton, Baker IDI Heart & Diabetes Institute, PO Box 6492, St. Kilda Road Central, Melbourne Victoria 8008, Australia (Email: michael.skilton{at}bakeridi.edu.au).

Objectives: We sought to develop a noninvasive technique to quantify the thickness of a segment of the carotid artery wall that incorporates the adventitia and to identify whether differences in this measure are associated with cardiovascular risk factors.

Background: There is increasing evidence that the arterial adventitia undergoes extensive structural alteration, including thickening, in response to arterial injury. However, there is currently no widely accepted noninvasive technique for studying the thickness of the arterial adventitia in humans.

Methods: The carotid artery and jugular vein were imaged simultaneously in longitudinal section with the use of high-resolution ultrasound. The distance from the jugular intima-lumen interface to the carotid media-adventitia margin was denominated as the carotid extra-media thickness (EMT). This measure includes the arterial adventitia but not the arterial intima or media. We measured the carotid EMT and intima-media thickness (IMT) in 175 subjects, including 54 with diabetes, 43 with dyslipidemia, 26 with other cardiovascular risk factors, and 52 healthy control subjects.

Results: When compared with control subjects, the EMT was increased in both the diabetes (p < 0.0001) and dyslipidemia (p = 0.04) groups. Multivariate linear regression analyses revealed that diabetes, high-density lipoprotein cholesterol (inverse association), and systolic blood pressure (J-shaped association) were the factors most strongly associated with EMT. These associations appear to be independent of carotid IMT.

Conclusions: Carotid EMT can be assessed by ultrasonography. It is physically distinct from IMT and provides additional information concerning the vascular changes associated with cardiovascular risk factors. As such, the measurement of EMT, in addition to IMT, may provide a more complete indication of the structural modification of the vasculature associated with cardiovascular risk factors than that obtained by the measurement of carotid IMT alone.

Key Words: adventitia • atherosclerosis • high-density lipoprotein cholesterol • diabetes • imaging • ultrasound • intima-media thickness • cardiovascular risk

Abbreviations and Acronyms   BMI = body mass index   EMT = extra-media thickness   HDL-C = high-density lipoprotein cholesterol   IMT = intima-media thickness   SBP = systolic blood pressure

Related Article

Atherosclerotic Plaque, Adventitia, Perivascular Fat, and Carotid Imaging

Erling Falk, Troels Thim, and Ingrid Bayer Kristensen
J. Am. Coll. Cardiol. Img. 2009 2: 183-186. [Full Text] [PDF]

This article has been cited by other articles:

				E. Falk, T. Thim, and I. B. Kristensen Atherosclerotic plaque, adventitia, perivascular fat, and carotid imaging. J. Am. Coll. Cardiol. Img., February 1, 2009; 2(2): 183 - 186. [Full Text] [PDF]