title: One, two and three-dimensional ultrasound measurements of carotid atherosclerosis before and after cardiac rehabilitation: preliminary results of a randomized controlled trial.
abstract: BACKGROUND
  It is still not known how patients who are post-transient ischemic attack (TIA) or post-stroke might benefit from prospectively planned comprehensive cardiac rehabilitation (CCR). In this pilot evaluation of a larger ongoing randomized-controlled-trial, we evaluated ultrasound (US) measurements of carotid atherosclerosis in subjects following TIA or mild non-disabling stroke and their relationship with risk factors before and after 6-months of CCR.
  
  
  METHODS
  Carotid ultrasound (US) measurements of one-dimensional intima-media-thickness (IMT), two-dimensional total-plaque-area (TPA), three-dimensional total-plaque-volume (TPV) and vessel-wall-volume (VWV) were acquired before and after 6-months CCR for 39 subjects who had previously experienced a TIA and provided written informed consent to participate in this randomized controlled trial. We maintained blinding for this ongoing study by representing treatment and control groups as A or B, although we did not identify which of A or B was treatment or control. Carotid IMT, TPA, TPV and VWV were measured before and after CCR as were changes in body mass index (BMI), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), systolic blood pressure (SBP) and diastolic blood pressure (DBP).
  
  
  RESULTS
  There were no significant differences in US measurements or risk factors between groups A and B. There was no significant change in carotid ultrasound measurements for group A (IMT, p = .728; TPA, p = .629; TPV, p = .674; VWV, p = .507) or B (IMT, p = .054; TPA, p = .567; TPV, p = .773; VWV, p = .431) at the end of CCR. There were significant but weak-to-moderate correlations between IMT and VWV (r = 0.25, p = .01), IMT and TPV (r = 0.21, p = .01), TPV and TPA (r = 0.60, p < .0001) and VWV and TPV (r = 0.22, p = .02). Subjects with improved TC/HDL ratios showed improved carotid VWV although, this was not statistically significant.
  
  
  CONCLUSIONS
  In this preliminary evaluation, there were no significant differences in carotid US measurements in the control or CCR group; a larger sample size and/or longer duration is required to detect significant changes in US or other risk factor measurements.
authors.forename: Tamas J
authors.initials: TJ
authors.lastname: Lindenmaier
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Buchanan
authors.forename: Damien
authors.initials: D
authors.lastname: Pike
authors.forename: Tim
authors.initials: T
authors.lastname: Hartley
authors.forename: Robert D
authors.initials: RD
authors.lastname: Reid
authors.forename: J David
authors.initials: JD
authors.lastname: Spence
authors.forename: Richard
authors.initials: R
authors.lastname: Chan
authors.forename: Michael
authors.initials: M
authors.lastname: Sharma
authors.forename: Peter L
authors.initials: PL
authors.lastname: Prior
authors.forename: Neville
authors.initials: N
authors.lastname: Suskin
authors.affiliation: Imaging Research Laboratories, Robarts Research Institute, 1151 Richmond St, London, ON N6A 5B7, Canada. gparraga@robarts.ca.
authors.forename: Grace
authors.initials: G
authors.lastname: Parraga
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000534:rehabilitation*; D004452:Echocardiography / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging* / Q000209:etiology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome