Carotid Wall Elastography to Assess Midterm Vascular Dysfunction Secondary to Intrauterine Growth Restriction: Feasibility and Comparison with Standardized Intima-Media Thickness

Several studies have suggested that intrauterine growth restriction (IUGR) increases the risk of cardiovascular disease and early atherosclerosis. Early detection of arteriopathy is essential to early intervention. Although arterial intima-media thickness (IMT) is considered an index of subclinical atherosclerosis in the adult, its validity in pediatric patients may be limited. We have recently introduced a novel imaging-based biomarker (ImBioMark) to assess intrinsic mechanical features of the arterial wall from B-mode ultrasound data. The aim of the work described here was to evaluate the potential of ImBioMark in investigation of cardiovascular health status at the level of the common carotid artery (CCA) in adolescents born after IUGR. We also compared ImBioMark results with automated IMT measurements, a well-established biomarker used in clinical practice and research. The potential sequelae of IUGR on the CCA were examined in a group of adolescents in comparison with healthy controls. Patients with IUGR (n = 7) were 13.85 ± 0.46 y old; the healthy controls (n = 7) were 14.58 ± 0.80 y old (p = 0.058). Cine loops of the CCA B-mode data were digitally recorded, and the arterial elastic modulus was estimated a posteriori with ImBioMark. IMT of the CCA was automatically calculated using QLAB software (Philips, Andover, MA, USA). All patients had been evaluated in utero in our fetal echocardiographic laboratory. ImBioMark detected a significant increase in CCA stiffness in patients with IUGR as compared with healthy controls: elastic modulus = 90.74 ± 11.86 versus 61.30 ± 15.94 kPa, respectively (p = 0.002). There was, however, no significant difference between patients with IUGR and controls in IMT (0.483 ± 0.067 versus 0.476 ± 0.051 mm, respectively, p = 0.831). The impact of IUGR on CCA wall dynamics was confirmed by ImBioMark. The apparent limitation of IMT measurement in this cohort may be the result of geometric arterial changes, that is, the expected thickening, below the level of detection at this age. As early detection of vascular modulation is essential to early intervention in a population at risk, we now intend to extend ImBioMark to investigate larger pathologic cohorts with various degrees of arteriopathy.