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Carotid Artery Distensibility

A Reliability Study

Elisa Cuadrado Godia, MD, Rishi Madhok, John Pittman, PhD, Samuel Trocio, MD, Romel Ramas, MD, Digna Cabral, BS, Ralph L. Sacco, MD, MS and Tatjana Rundek, MD, PhD

Department of Neurology, Division of Stroke (E.C.G., R.M., J.P., S.T., R.R., D.C., R.L.S., T.R.), Sergievsky Center (R.L.S.), and Department of Epidemiology (R.L.S.), Columbia University and Mailman School of Public Health, New York, New York USA. Dr Godia is currently with Hospital del Mar, Barcelona, Spain.

Address correspondence to Tatjana Rundek, MD, PhD, Department of Neurology, Miller School of Medicine, University of Miami, 1120 NW 14th St, Suite 850, Miami, Fl 33136 USA. E-mail. trundek{at}med.miami.edu

Objective. Carotid distensibility (CD) is a measure of carotid artery elasticity that has been introduced as a risk factor for cardiovascular disease. Information regarding reproducibility of sonographic CD measures is limited. The objective of this study was to evaluate the inter-reader reliability of sonographic measurements of common carotid artery (CCA) diameters and derived metrics of CD. Methods. Two independent readers (R1 and R2) measured the systolic diameter (SD) and diastolic diameter (DD) for the right CCA from the B/M-mode sonographic registrations among 118 subjects. The derived CD metrics (strain, elastic modulus [E], stiffness [ß], and CD) were calculated. The inter-reader type 3 intraclass correlation coefficients (ICC3,1) for carotid diameters were calculated. Results. The mean SDs ± standard deviation were 7.15 ± 1.43 mm for R1 and 7.24 ± 1.43 mm for R2. The mean DDs were 6.71 ± 1.36 mm for R1 and 6.68 ± 1.41 mm for R2. The mean differences of SD and DD between R1 and R2 were 0.08 ± 0.40 mm (paired t test, P = .04) and 0.03 ± 0.43 mm (paired t test, P = .46), respectively. Inter-reader type 3 intraclass correlation coefficients were 0.96 for SD and 0.95 for DD. We observed a significant association of demographics with carotid diameters but not with derived CD metrics or risk factors. Conclusions. Our results suggest good reproducibility of CCA diameters measured with B/M-mode sonography. However, very small changes in linear measurements of carotid diameters can have big effects on estimates of arterial mechanical properties such as strain and Young’s modulus. The standard boundary identification methods may not be precise and reproducible enough for use in a clinical setting.

Key Words: atherosclerosis • carotid distensibility • carotid sonography • reliability

Abbreviations: ARIC, Atherosclerosis Risk in Communities • BLSA, Baltimore Longitudinal Study of Aging • BP, blood pressure • CCA, common carotid artery • CD, carotid distensibility • CVD, cardiovascular disease • DBP, diastolic blood pressure • DD, diastolic diameter • ICC, intraclass correlation coefficient • IMT, intima-media thickness • MESA, Multiethnic Study of Atherosclerosis • NOMAS, Northern Manhattan Study • SBP, systolic blood pressure • SD, systolic diameter • SMART, Second Manifestations of Arterial Disease