Assessment of Carotid Arterial Stiffness in Community Settings with ARTSENS®

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 (β), pressure-strain elastic modulus (Ep), arterial compliance (AC), and one-point pulse wave velocity (PWVβ) 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 ∼80% of arterial diameter values. The average RDs for β, Ep, AC, and PWVβ, were 20.51%, 22.31%, 25.10%, and 14.13%, respectively. Typical range for stiffness indices among females and males were β : 8.12 ± 3.59 vs 6.51 ± 2.78, Ep : 113.24 ± 56.12 kPa vs 92.33 ± 40.65 kPa, PWVβ : 6.32 ± 1.38 ms-1 vs 5.81 ± 1.16 ms-1, and AC: 0.54 ± 0.36 mm2 kPa-1 vs 0.72 ± 0.38 mm2 kPa-1. Mean β, Ep, and PWVβ 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 Ep ≥ 93.71 kPa and/or PWV β≥6.56 ms-1 was ≥ 2.12 or above in males. In females, it was just above 2.00 for Ep ≥ 91.21 kPa and/or PWVβ ≥ 5.10 ms-1 and increased to ≥ 3.33 for Ep ≥ 143.50 kPa and ≥ 3.25 for PWVβ ≥ 7.31 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.