eTRACKING

Comprehensive Evaluation and Detection of Early Atherosclerosis by Ultrasound

One single measurement provides us with multiple parameters necessary for the evaluation of early atherosclerosis. eTRACKING permits more comprehensive and objective evaluation.

eTRACKING achieves highly precise measurements of the vessel diameter in real time, using radio frequency (RF) signals. Conventionally, vessel diameters are measured visually on B-mode and M-mode images, this can lead to variations in the measurement because it is impossible to know timedependent changes in the vessel diameter on B-mode. Furthermore it is difficult to identify exact timing for the measurement of the maximum and minimum diameter. To overcome these problems in measuring vessel diameter, eTRACKING has been developed and implemented in a diagnostic Cardiovascular Ultrasound system.

Principle of eTRACKING

Adventitia

Media

Intima

Movement of the vessel wall is tracked automatically by simply setting the tracking gate on the B-mode image. Calculates vessel diameter very accurately by using the RF signal. The 10 MHz probe achieves 0.01 mm accuracy. Displays waveforms of changes in vessel diameter (distension wave) in real time. Automatically calculates various parameters, and displays the results. Easier to operate than conventional methods, applicable to routine examination and shortens examination time. Non-invasive examinations allows easier and faster repetition.

B-mode image Tracking gate Tracking cursor

RF signal

Magnified figure of received RF signal

Wall movement

Intima Adventitia
Zero-crossing point

Zero-crossi point

Received signal (t)

Received signal (t{

1)

Tracking waveforms

First, set the tracking gate at the zero-crossing point on an RF signal (t). The received RF signal (t + 1) is displaced as the vessel wall moves with the heartbeat. At this time, the tracking gate automatically detects the zero-crossing point on the RF signal (t + 1) and moves accordingly. This process is repeated to track the movement of the vessel wall automatically and accurately.

Distension wave

Numerical and graphical display of the results:

Procedure: Select several distension waves detected by eTRACKING. The selected waveforms will be ensemble-averaged. Averaging provides more stable results with fewer variations. The maximum and minimum vessel diameters of the ensemble-averaged distension waveform are used for the automated calculation of various parameters, which are useful for the assessment of atherosclerosis.

Ensemble-averaged distension waveform Display of parameters Ensemble-averaged ECG waveform

Distension waveforms

ECG waveforms

Parameters:
: Stiffness parameter Ep : Pressure-strain elastic modulus AC : Arterial compliance PWV: One-point pulse wave velocity (PWV) calculated from value AI : Augmentation Index D max : Maximum vessel diameter D min : Minimum vessel diameter P max : Systolic blood pressure P min : Diastolic blood pressure R-R : R-R interval on ECG HR : Heart rate

Clinical Applications:
Early detection of atherosclerosis Quantitative assessment of arterial stiffness is feasible before the onset of organic changes, such as vessel wall thickening and plaque formation. Determining efficacy of treatment Useful in determining the efficacy of medication or after removing risk factors Estimating blood vessel age to help prevent atherosclerosis Applicable to a complete medical checkup of healthy people to estimate their blood vessel age, so that they can be instructed to improve their lifestyle through diet and exercise to prevent atherosclerosis. Follow-up of lifestyle improvement Serves as an index for lifestyle improvements follow-up through exercise and diet.

Arterial Function assessment

The performance of eTRACKING in the quantitative assessment of atherosclerosis has been enhanced by adding PWV and AI to the conventional parameters. It provides multiple parameters necessary for assessing atherosclerosis at a single measurement, thus making the assessment more comprehensive and objective. (stiffness parameter): index of arterial stiffness = In (Ps / Pd) / [(Ds Dd) / Dd] Calculated from changes in vessel diameter and blood pressure Arterial stiffness value Less dependent on blood pressure Ps: systolic pressure; Pd: diastolic pressure; Ds: maximum vessel diameter; Dd: minimum vessel diameter

Ep (pressure-strain elasticity modulus): index of vessel elasticity Ep = (Ps Pd) / [(Ds Dd) / Dd ] Ps: systolic pressure; Pd: diastolic pressure; Ds: maximum vessel diameter; Dd: minimum vessel diameter

Calculated from changes in vessel diameter and blood pressure Arterial elasticity Ep Blood pressure dependency: The value greatly varies with blood pressure even in the same blood vessel. AC (arterial compliance): index of blood vessel compliance AC = (Ds ~ Ds - Dd~ Dd) / [4 (Ps Pd)] Calculated from changes in blood vessel cross-sectional area and blood pressure Arterial compliance AC PWV@

Ps: systolic pressure; Pd: diastolic pressure; Ds: maximum vessel diameter; Dd: minimum vessel diameter

One-point pulse wave velocity: index for arterial stiffness Definitional equation C i P / 2j @ P: diastolic pressure : blood density (1050 Kg/m3)

Local pulse wave velocity calculated from stiffness parameter AI (Augmentation Index): index representing proportion of a reflected wave A pulse wave consists of a forward-wave component and a reflected-wave component. The reflected wave is greater when the resistance is higher in a peripheral artery, i.e., when the patient is older or the atherosclerosis has progressed further. AI indicates the proportion of a reflected wave to the pulse pressure. The AI value is greater when the reflected wave is higher or takes a shorter time to come back. This index is useful for early detection of atherosclerosis and prevention of hypertension and hypertrophic cardiomyopathy.

AI=P/ PP

PP

Endothelial Function Assessment by Flow Mediated Dilatation (FMD)

Flow Mediated Dilatation (FMD) is known as an index of endothelial function that can be measured noninvasively. Features of FMD analysis by eTRACKING include: 1. Measurement of minute vasodilatation with 0.01mm accuracy 2. Continuous recording and graphical display of the whole process, i.e., baseline, cuff occlusion, vasodilation and recovery. 3. Automated calculation of parameters, such as vessel diameter at maximum dilatation and %FMD Arm holder table Cuff Probe Probe fixing unit

Cuff occlusion

Cuff release Peak vasodilatation

% FMD = (Peak Diameter Baseline Diameter) / Baseline Diameter Base: vessel diameter at baseline Peak: vessel diameter at peak vasodilatation 30s: vessel diameter at 30sec after cuff releasing 60s: vessel diameter at 60sec after cuff releasing Time: time from cuff releasing to peak vasodilatation

Systole: Calculated from systolic maximum vessel diameter Diastole: Calculated from diastolic minimum vessel diameter

Clinical Applications:
Early detection of atherosclerosis Endothelial dysfunction is considered to be the first step to the atherosclerosis. Detection at this stage can help prevent atherosclerosis from progressing. Determining efficacy of treatment FMD can be used as an index for evaluating the improvement of endothelial function after removing risk factors through exercise, diet and medication. Some researchers have reported that FMD can be improved by treatment with medicines for hypertension and hyperlipidemia, estrogens, vitamin E, and vitamin C.