title: Relation of carotid artery diameter with cardiac geometry and mechanics in heart failure with preserved ejection fraction.
abstract: BACKGROUND
  Central artery dilation and remodeling are associated with higher heart failure and cardiovascular risks. However, data regarding carotid artery diameter from hypertension to heart failure have remained elusive. We sought to investigate this issue by examining the association between carotid artery diameter and surrogates of ventricular dysfunction.
  
  
  RESULTS
  Two hundred thirteen consecutive patients including 49 with heart failure and preserved ejection fraction (HFpEF), 116 with hypertension, and an additional 48 healthy participants underwent comprehensive echocardiography and tissue Doppler imaging. Ultrasonography of the common carotid arteries was performed for measurement of intima-media thickness and diameter (CCAD). Cardiac mechanics, including LV twist, were assessed by novel speckle-tracking software. A substantial graded enlargement of CCAD was observed across all 3 groups (6.8 ± 0.6, 7.7 ± 0.73, and 8.7 ± 0.95 mm for normal, hypertension, and HFpEF groups, respectively; ANOVA P<0.001) and correlated with serum brain natriuretic peptide level (R(2)=0.31, P<0.001). Multivariable models showed that CCAD was associated with increased LV mass, LV mass-to-volume ratio (β-coefficient=10.9 and 0.11, both P<0.001), reduced LV longitudinal and radial strain (β-coeffficient=0.81 and -3.1, both P<0.05), and twist (β-coefficient=-0.84, P<0.05). CCAD set at 8.07 mm as a cut-off had a 77.6% sensitivity, 82.3% specificity, and area under the receiver operating characteristic curves (AUROC) of 0.86 (95% CI 0.80 to 0.92) in discriminating HFpEF. In addition, CCAD superimposed on myocardial deformation significantly expanded AUROC (for longitudinal strain, from 0.84 to 0.90, P of ΔAUROC=0.02) in heart failure discrimination models.
  
  
  CONCLUSIONS
  Increased carotid artery diameter is associated with worse LV geometry, higher brain natriuretic peptide level, and reduced contractile mechanics in individuals with HFpEF.
authors: Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
authors: Zhen-Yu
authors: ZY
authors: Liao
authors: Ming-Cheng
authors: MC
authors: Peng
authors: Chun-Ho
authors: CH
authors: Yun
authors: Yau-Huei
authors: YH
authors: Lai
authors: Helen L
authors: HL
authors: Po
authors: Charles Jia-Yin
authors: CJ
authors: Hou
authors: Jen-Yuan
authors: JY
authors: Kuo
authors: Chung-Lieh
authors: CL
authors: Hung
authors: Yih-Jer
authors: YJ
authors: Wu
authors: Bernard E
authors: BE
authors: Bulwer
authors: Hung-I
authors: HI
authors: Yeh
authors: Cheng-Ho
authors: CH
authors: Tsai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003971:Diastole / Q000502:physiology; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000503:physiopathology*; D006352:Heart Ventricles / Q000473:pathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D014057:Tomography, X-Ray Computed; D018487:Ventricular Dysfunction, Left; D020257:Ventricular Remodeling / Q000502:physiology
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: cardiac mechanics; carotid artery diameter; heart failure; hypertension; remodeling; strain