Characterization of carotid remodeling in gestational hypertension using radiofrequency data-based vessel stiffness analysis and vector flow imaging.

BACKGROUND: Gestational hypertension (GH) is associated with maternal vascular remodeling; however, the biomechanical and hemodynamic features related to increased carotid intima-media thickness (CIMT) remain insufficiently characterized. This study aimed to evaluate carotid remodeling in women with GH using radiofrequency data-based quantitative vessel stiffness (R-QVS) analysis and vector flow imaging (VFI). METHODS: This prospective observational study included 347 pregnant women, comprising 108 normotensive controls and 239 women with GH. The GH group was further divided into normal-CIMT and increased-CIMT subgroups based on a mean CIMT threshold of 1.0 mm. All participants underwent standardized carotid ultrasonography. Stiffness-related parameters, including the hardness coefficient (HC) and pulse wave velocity (PWV), and flow-related parameters, including maximum wall shear stress (WSSmax) and mean wall shear stress (WSSmean), were measured. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis, and the factors associated with increased CIMT were evaluated using logistic and linear regression analyses. RESULTS: Carotid stiffness increased and wall shear stress (WSS) decreased progressively from the control group to the GH normal-CIMT and GH increased-CIMT groups. The GH increased-CIMT group had the highest PWV and the lowest WSSmean. The PWV values were 5.87±0.68, 7.05±0.77, and 8.11±0.85 m/s in the control, GH normal-CIMT, and GH increased-CIMT groups, respectively, while the WSSmean values were 1.30±0.38, 0.89±0.32, and 0.65±0.27 Pa, respectively; all group differences were statistically significant. The HC and PWV showed strong diagnostic performance in the detection of increased CIMT, with areas under the curve (AUCs) of 0.909 and 0.885, respectively. In the multivariable logistic regression analysis, pre-pregnancy body mass index (BMI), systolic blood pressure (SBP), triglycerides (TG), and PWV were independently associated with increased CIMT, while WSSmean was higher WSSmean was independently associated with lower odds of increased CIMT. In the linear regression analysis, the same key predictors were associated with CIMT as a continuous outcome, and the model explained 56.8% of variance in CIMT, with an adjusted R2 of 0.553. CONCLUSIONS: Women with GH exhibited a progressive high-stiffness and low-shear carotid phenotype, particularly in the presence of increased CIMT. Integrating R-QVS analysis and VFI may improve vascular risk stratification in hypertensive pregnancies.