Evaluation of the ultrasonic arterial measurement and analysis system for predicting 10-year atherosclerotic cardiovascular disease risk in patients with type 2 diabetes

Figures

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  Figure 1. Measurement of cfPWV by ultrasonic AMAS system. Based on ECG-gated Doppler spectrum at the RCCA (A) and RCFA (B), the AMAS system automatically recognizes the starting point of the pulse wave (dashed yellow line) and the tip of the R wave of the ECG (dashed green line), and then automatically measures the time delay from the starting point of the pulse wave to the tip of the R wave of the ECG, which is recorded as “Carotid-R Time” for the RCCA, and as “Femoral-R Time” for the RCFA. The transit time (ΔT) can be calculated as “Femoral-R Time” minus “Carotid-R Time”. The cfPWV can be calculated as L divided by ΔT. The results of 10 stable cardiac cycles are shown in the (C), as is the value of cfPWV for our study. AMAS, automatic measurement of arterial stiffness; cfPWV, carotid-femoral pulse wave velocity; ECG, electrocardiogram; RCCA, right common carotid artery; RCFA, right common femoral artery.

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  Figure 2. Measurement of cIMT by high-frequency ultrasound. (A) shows a longitudinal image of the RCCA. (B) shows a zoomed longitudinal image of the RCCA. The vertical distance between the anterior edge of the inner hyperechoic layer to the anterior edge of the outer hyperechoic layer of the posterior wall of the RCCA is the cIMT (red arrows). At the peak of the R wave on the ECG, the intima-media thickness was measured at 1.5, 2.0, and 2.5 cm proximal to the carotid bifurcation and the white arrow indicating the carotid bifurcation (C). cIMT, carotid intima-media thickness; ECG, electrocardiogram; RCCA, right common carotid artery.

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  Figure 3. Flow diagram of subject inclusion. cfPWV, carotid-femoral pulse wave velocity; T2DM, type 2 diabetes mellitus.

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  Figure 4. The violin plot shows the distribution of cfPWV among the different risk categories. *, P<0.05 for multiple comparison; **, P<0.001 for multiple comparison. cfPWV, carotid-femoral pulse wave velocity.

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  Figure 5. The violin plot shows the distribution of cIMT among the different risk categories. *, P<0.05 for multiple comparison; **, P<0.001 for multiple comparison. cIMT, carotid intima-media thickness.

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  Figure 6. Relationship between cfPWV and the 10-year ASCVD risk by a scatterplot. The red realization is the linear fitting curve. The black dashed lines are the 95% confidence interval. 10-year ASCVD risk (%) calculated by the China-PAR model. cfPWV, carotid-femoral pulse wave velocity; ASCVD, atherosclerotic cardiovascular disease; China-PAR, prediction for ASCVD risk in China; cfPWV, carotid-femoral pulse wave velocity.

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  Figure 7. Percent stacked charts of 10-year ASCVD risk stratification of study population (n=126) in the cfPWV quartiles subgroups. The Mantel-Haenszel chi-square test was used to explore the trend of 10-year ASCVD risk grades with different cfPWV levels. cfPWV was divided into 4 levels by quartiles (Q1–Q4), and the 10-year ASCVD risk, as assessed by the China-PAR model, were categorized into 3 groups (low-, moderate-, and high-risk). The Mantel-Haenszel chi-square test results revealed a linear relationship between cfPWV levels and 10-year ASCVD risk grades (χ2=52.870, P<0.001). Pearson correlation results showed that the 10-year ASCVD risk grade increased with the increase of cfPWV level (R=0.650, P<0.001). ASCVD, atherosclerotic cardiovascular disease; cfPWV, carotid-femoral pulse wave velocity; China-PAR, prediction for ASCVD risk in China.

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  Figure 8. ROC curves of cfPWV and cIMT for discriminating a high 10-year ASCVD risk in the patients with T2DM. High 10-year ASCVD risk was defined as 10-year ASCVD risk of 10% or more, as calculated by the China-PAR model. cfPWV demonstrated an AUC of 0.852 (95% CI: 0.782–0.922). cIMT demonstrated an AUC of 0.722 (95% CI: 0.630–0.814). ASCVD, atherosclerotic cardiovascular disease; AUC, area under the curve; cIMT, carotid intima-media thickness; cfPWV, carotid-femoral pulse wave velocity; China-PAR, prediction for ASCVD risk in China; CI, confidence interval; ROC, receiver operating characteristic.