Tele-ultrasound in community with limited resources: The association of hypertension on reduced carotid artery circumferential strain

Introduction: Stroke is one of the leading causes of death worldwide, in majority triggered by modifiable risk factors such as hypertension. AIM: to assess relations between hypertension and carotid arteries radial and circumferential deformation, assessing a population of participants after a first ischemic stroke and healthy controls. Methods: Retrospective study, from 2016 to 2017, with a sample of the PAI project control group, an urban population of the São Francisco Valley in the Northeast of Brazil, 105 people between 40-80 years-old, including patients after a first episode of ischemic stroke in the absence of known cardiovascular disease; and a control group of healthy volunteers, matched by age, sex, and presence of hypertension. Asynchronous analysis was performed by tele-ultrasonography of carotid artery ultrasound with images acquisition of EKG-synchronized videos in cross-section of the common carotid artery bilaterally and then strain values were acquired by Speckle Tracking technique, computing the mean circumferential and radial peaks of both carotids. Univariate and multivariable analyses assessed the association between carotid strain and hypertension. Results: 84 participants had analyzable images (29 patients after a first episode of stroke). The mean age was 60.5 + 11.6 years, 46.5% were women, 70.2% had hypertension. Radial deformation was lower but non-significant in participants with hypertension compared to those without hypertension (-3.13% vs. -3.35%, respectively, p = 0.54). There was significantly less circumferential deformation among participants who had hypertension compared to those without hypertension (4.16% vs. 5.3%, respectively, p = 0.003). Hypertension maintained association with lower circumferential strain in multivariate analysis (coef = -1.13; p = 0.019). Conclusion: hypertension was independently associated with the decrease in the carotid artery circumferential deformation. Tele-ultrasound associated with carotid strain analysis shows promising results for the evaluation of subclinical changes in carotid arteries in populations with limited resources in remote regions such as the Northeast of Brazil.