Surrogate Markers of Cardiovascular Disease in CKD: What's Under the Hood?  Mario F. Rubin, MD, Sylvia E. Rosas, MD, Julio A. Chirinos, MD, Raymond R. Townsend, MD  American Journal of Kidney Diseases  Volume 57, Issue 3, Pages 488-497 (March 2011) DOI: 10.1053/j.ajkd.2010.08.030 Copyright © 2011 National Kidney Foundation, Inc. Terms and Conditions

Figure 1 (A) Shows carotid intima-media thickness (IMT) determined using ultrasound imaging; the area within the green square has been selected as the region of interest (ROI) for measurement. The mean IMT of 0.71 mm is measured in this segment of the carotid far wall [F] between the yellow (edge of intima) and pink (edge of media) lines (normal values are age-/sex-specific; for this patient, normal is 0.71 mm). (B) A short-axis image of the left ventricle in end-diastole; the letters refer to orientation (H, head; F, foot; A, anterior; P, posterior). The circular dark area with the green arrows is the left ventricular wall. The ventricular wall area is measured from this image and multiplied by slice thickness to obtain the myocardial volume contained in this slice, which is multiplied by myocardial density to obtain mass. The same is made for different slices, and total left ventricular mass (LVM) equals the sum of LVM in individual slices. This individual's LVM was 275 g, and body height was 1.75 m. Therefore, LVM indexed for height1.7 was 106 g/m1.7. Normal values for this individual's sex and race are ≤80 g/m1.7. This is an example of left ventricular hypertrophy. (C) Shows output from a carotid-femoral pulse wave velocity (PWV) determination. The PWV is determined by subtracting the proximal time to waveform detection at the carotid site (mean time, 104.8 ms) from the distal waveform detection time at the femoral site (mean time, 151.3 ms) for a value of 46.5 ms. The distance the pulse wave traveled in this patient was 470 mm. Dividing the distance by the time yields velocity; 10.1 m/s in this case (normal values are age-specific and affected by blood pressure levels; they range from 6 m/s at age 30 to ∼10 m/s at age 70 years in the absence of hypertension). (D) Provides data from an ankle-brachial index measurement obtained using a standard blood pressure cuff and Doppler ultrasound probe to detect blood flow in systole at the elbow (brachial) and ankle sites (dorsalis pedis in this case). The index is derived by dividing the ankle site value by the brachial site value (104 mm Hg/132 mm Hg = 0.79; normal values, >0.90-1.40). Abbreviations: ECG, electrocardiogram, HR, heart rate; SD, standard deviation. American Journal of Kidney Diseases 2011 57, 488-497DOI: (10.1053/j.ajkd.2010.08.030) Copyright © 2011 National Kidney Foundation, Inc. Terms and Conditions