Carotid artery intima-media thickness measurements in the youth: reproducibility and technical considerations

Elif Seda Selamet Tierney; Kimberlee Gauvreau; Michael R Jaff; Dana Gal; Susan E Nourse; Shari Trevey; Stephen O'Neill; Annette Baker; Jane W Newburger; Steven D Colan

doi:10.1016/j.echo.2014.10.004

Carotid artery intima-media thickness measurements in the youth: reproducibility and technical considerations

J Am Soc Echocardiogr. 2015 Mar;28(3):309-16. doi: 10.1016/j.echo.2014.10.004. Epub 2014 Nov 20.

Affiliations

¹ Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California. Electronic address: tierneys@stanford.edu.
² Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
³ Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
⁴ Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California.

PMID: 25459501
DOI: 10.1016/j.echo.2014.10.004

Abstract

Background: Carotid artery intima-media thickness (CIMT), a marker of atherosclerosis, is increased in youth at risk for future cardiovascular disease. Some pediatric studies have used CIMT as a primary outcome in clinical trials, yet data are limited on the standardization of methodology in children. The goal of this study was to evaluate reproducibility of CIMT measurements using two different measurement techniques.

Methods: Carotid artery ultrasound studies of children and adolescents obtained as a component of a research study in Kawasaki syndrome were retrospectively analyzed. The CIMTs of both common carotid arteries (CCAs) were measured by one of two sonographers at the time in the cardiac cycle when resolution subjectively was determined to be optimal (Opt-CIMT). These sonographers blindly remeasured a random sample of studies of their own and each other's, using the same method. Another observer made CIMT measurements using exclusively frames on the R wave (R-CIMT). A fourth observer independently measured a random sample of studies twice with the R-CIMT method.

Results: Carotid artery images from 184 subjects (mean age, 14.7 ± 2.2 years) were analyzed. The intraclass correlation coefficient for interobserver variability was 0.86 (95% confidence interval [CI], 0.69-0.94) compared with 0.85 (95% CI, 0.65-0.93) for the right and 0.86 (95% CI, 0.67-0.94) versus 0.95 (95% CI, 0.87-0.98) for the left CCA for Opt-CIMT and R-CIMT, respectively. R-CIMT was significantly thicker than Opt-CIMT (right CCA, 0.439 ± 0.030 vs 0.428 ± 0.024 mm, P < .001; left CCA, 0.446 ± 0.030 vs 0.434 ± 0.025 mm, P < .001).

Conclusion: Pediatric CIMT measurements have excellent reproducibility when the same methodology is applied but vary significantly throughout the cardiac cycle. This report highlights the need to standardize CIMT measurements in the youth and supports the use of electrocardiographic timing, as recommended in adults, in pediatric longitudinal studies.

Keywords: Atherosclerosis; Carotid artery IMT; Carotid artery ultrasound; Reproducibility; Variability; Youth.

Publication types

Comparative Study
Evaluation Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Algorithms*
Carotid Arteries / diagnostic imaging*
Carotid Intima-Media Thickness*
Child
Echocardiography / methods*
Female
Humans
Image Enhancement / methods
Image Interpretation, Computer-Assisted / methods*
Male
Observer Variation
Reproducibility of Results
Sensitivity and Specificity
Single-Blind Method
Young Adult