Key result
Major cardiovascular risk factors are linked to higher CIMT variability, reducing measurement consistency.
Why the study?
It is unclear to what extent the cardiac cycle influences carotid intima-media thickness values, particularly in individuals with major cardiovascular risk factors.
Does the cardiac cycle influence carotid intima-media thickness (CIMT) variability, and is this variability associated with major cardiovascular risk factors?
Cohort (n=9,546)
Yes
Does the cardiac cycle influence carotid intima-media thickness (CIMT) variability, and is this variability associated with major cardiovascular risk factors?
Carotid intima-media thickness varies significantly across the cardiac cycle, particularly in patients with cardiovascular risk factors, highlighting the need for standardized ECG-gated image acquisition to prevent measurement interference.
CIMT variability may reduce measurement reliability in patients with CVRFs; leaves open whether ECG-gating improves reproducibility.
Background/Introduction It is unclear to what extent the cardiac cycle influences carotid intima-media thickness (CIMT) values, especially in individuals with major cardiovascular risk factors (CVRF). Purpose To analyze CIMT variability throughout the cardiac cycle using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) and its association with major CVRFs (hypertension, diabetes, dyslipidemia, smoking and family history of premature cardiovascular disease). Methods Our sample consisted of 9,546 participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) with valid left and right CIMT values. ELSA-Brasil is a cohort study of individuals aged 35 to 74 years in six Brazilian cities. CIMT image acquisition was performed using ECG-gated video recording of common carotid arteries during three cardiac cycles (70 to 90 frames each exam). CIMT reading was computer-assisted (MIA software), upon discretization of a 1-cm long region of interest to assess minimal, mean and maximum CIMT in each frame. In this analysis, we analyzed frame-by-frame data to calculate the coefficient of variation (CV), range, and interquartile range of CIMT measurements within each exam. Furthermore, we classified the sample according to the presence of major CVRFs. Results Our sample had a mean age of the sample was 51.5 years and 56% were women. CIMT variability was higher in individuals with major CVRFs, except for family history of premature cardiovascular disease As shown in Table 1, CIMT variability was relatively higher in proximal wall measurements (CV: 5.8% and 4.9% for left and right common carotid artery (CCA), respectively) than in far wall measurements (CV: 2.1% for both CCAs). For all measurements, a higher number of CVRFs were significantly associated with higher variability across the cardiac cycle (Table 2). Conclusion(s) There is a significant CIMT variability across the cardiac cycle, especially in individuals with established CVRFs. Study protocols and technicians must be aware of this phenomenon during image acquisition to ensure variability does not interfere with the study results.
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Lotufo et al. (2025) conducted a cohort in Cardiovascular risk factors (n=9,546). Major cardiovascular risk factors vs. Fewer or no major cardiovascular risk factors was evaluated on CIMT variability (coefficient of variation) throughout the cardiac cycle. Major cardiovascular risk factors were significantly associated with higher carotid intima-media thickness variability across the cardiac cycle (proximal wall CVs 5.8% and 4.9%, far wall CV 2.1%).
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