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Subclinical Atherosclerosis and Incipient Regional Myocardial Dysfunction in Asymptomatic Individuals

The Multi-Ethnic Study of Atherosclerosis (MESA)

Verônica R.S. Fernandes, MD, PhD^_*, Joseph F. Polak, MD, MPH, Thor Edvardsen, MD, PhD^_*, Benilton Carvalho, MSc, Antoinette Gomes, MD, David A. Bluemke, MD, PhD^_*,||, Khurram Nasir, MD, MPH^_*, Daniel H. O’Leary, MD and João A.C. Lima, MD, FACC^_*,||,_*

^_* Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
Division of Radiology, Tufts-New England Medical Center Department of Radiology, Boston, Massachusetts
Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
Department of Radiological Sciences, UCLA Medical Center, Los Angeles, California
^|| Department of Radiology, Johns Hopkins University, Baltimore, Maryland.

View larger version (16K): [in a new window]   Figure 1 Representative strain rate (upper) and circumferential shortening strain (lower) curves from one participant. This example is showing a typical strain rate pattern with a marked E-wave in early diastole and a less pronounced A-wave close to end diastole. ECC = shortening circumferential strain; ERE = E-wave from diastolic strain rate; SRA = A-wave from diastolic strain rate; SRS = peak systolic strain rate.

View larger version (19K): [in a new window]   Figure 2 Representative cartoon of a carotid artery showing the location for measurement in an ultrasound examination. The circle shows the common carotid segment used to measured intima-media thickness in our study.

View larger version (12K): [in a new window]   Figure 3 Direct linear relationships between increased intima-media thickness (IMT) and regional decreased function in the different myocardial regions; participants in the highest tertiles for carotid IMT (highest IMT) had decreased circumferential shortening strain in absolute values of circumferential shortening strain (ECC) in the lateral, inferior, and septal walls when compared with individuals in the lowest tertiles (less IMT).

View larger version (13K): [in a new window]   Figure 4 Mean diastolic strain rates in the different myocardial regions were significantly lower among individuals within the third tertile compared with the first intima-media thickness (IMT) tertile in the anterior, inferior, and septal walls (p < 0.05), as well as within the second IMT tertile as compared with those individuals in the first IMT tertile in the anterior and septal walls (p < 0.05). SRE = early diastolic strain rate (E-wave).