Assessment of Carotid Arterial Stiffness in Community Settings With ARTSENS®

Jayaraj Joseph, P M Nabeel, Sudha Ramachandra Rao, Ramachandran Venkatachalam, Malay Ilesh Shah, Prabhdeep Kaur

2020IEEE Journal of Translational Engineering in Health and Medicine35 citationsDOI Open Access PDF

Abstract

Objective: We investigate the field feasibility of carotid stiffness measurement using ARTSENS® Touch and report the first community-level data from India. Method: In an analytical cross-sectional survey among 1074 adults, we measured specific stiffness index ( <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\beta $ </tex-math></inline-formula> ), pressure-strain elastic modulus ( <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\text{E}_{\text {p}}$ </tex-math></inline-formula> ), arterial compliance (AC), and one-point pulse wave velocity (PWV <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$_{\beta }$ </tex-math></inline-formula> ) from the left common carotid artery. Data for established risk factors (waist circumference, blood pressure, plasma glucose, triglycerides, and HDL-C) were also collected. The association of carotid stiffness with age, gender, hypertension/diabetes, smoking, and clustering of risk factors was studied. Results: Measurements were repeatable with a relative difference (RD) between consecutive readings of < 5% for blood pressure and < 15% for <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\sim 80$ </tex-math></inline-formula> % of arterial diameter values. The average RDs for <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\beta $ </tex-math></inline-formula> , <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\text{E}_{\text {p}}$ </tex-math></inline-formula> , AC, and PWV <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$_{\beta }$ </tex-math></inline-formula> , were 20.51%, 22.31%, 25.10%, and 14.13%, respectively. Typical range for stiffness indices among females and males were <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\beta $ </tex-math></inline-formula> : 8.12 ± 3.59 vs 6.51 ± 2.78, <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\text{E}_{\text {p}}$ </tex-math></inline-formula> : 113.24 ± 56.12 kPa vs 92.33 ± 40.65 kPa, PWV <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$_{\beta }$ </tex-math></inline-formula> : 6.32 ± 1.38 ms −1 vs 5.81 ± 1.16 ms −1 , and AC: 0.54 ± 0.36 mm 2 kPa −1 vs 0.72 ± 0.38 mm 2 kPa −1 . Mean <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\beta $ </tex-math></inline-formula> , <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\text{E}_{\text {p}}$ </tex-math></inline-formula> , and PWV <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$_{\beta }$ </tex-math></inline-formula> increased (and mean AC decreased) across decades of age; the trend persisted even after excluding hypertensives and subjects with diabetes. The odds ratio of presence of multiple risk factors for <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\text{E}_{\text {p}} \ge93.71$ </tex-math></inline-formula> kPa and/or PWV <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$_{\beta } \ge6.56$ </tex-math></inline-formula> ms −1 was ≥ 2.12 or above in males. In females, it was just above 2.00 for <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\text{E}_{\text {p}} \ge91.21$ </tex-math></inline-formula> kPa and/or PWV <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$_{\beta } \ge5.10$ </tex-math></inline-formula> ms −1 and increased to ≥ 3.33 for <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$\text{E}_{\text {p}} \ge143.50$ </tex-math></inline-formula> kPa and ≥ 3.25 for PWV <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$_{\beta } \ge7.31$ </tex-math></inline-formula> ms −1 . Conclusion: The study demonstrated the feasibility of carotid stiffness measurement in a community setting. A positive association between the risk factors and carotid artery stiffness provides evidence for the device’s use in resource-constrained settings. Clinical Impact: The device paves the way for epidemiological and clinical studies that are essential for establishing population-level nomograms for wide-spread use of carotid stiffness in clinical practice and field screening of ‘at-risk’ subjects.

Topics & Concepts

Pulse wave velocityMathematicsArterial stiffnessNotationBlood pressureCombinatoricsMedicineInternal medicineArithmeticCardiovascular Health and Disease PreventionCerebrovascular and Carotid Artery DiseasesNon-Invasive Vital Sign Monitoring