Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Feasibility and reliability of carotid intima^media thickness measurements in nonsedated infants Yvan Mivelaz a,  , Stefano Di Bernardo a,  , Tatiana Boulos Ksontini a , Milan Prsa a , Yvan Vial b , Arnaud Chiolero c , and Nicole Sekarski a Introduction: Carotid intima–media thickness (CIMT) is a surrogate marker for atherosclerosis. It is increased in adolescents and young adults at risk for future cardiovascular disease. However, it remains unclear if it can be considered as a surrogate marker for atherosclerosis in infancy as very few studies have been performed in infants. Objectives: Our objective was to assess the feasibility and interobserver reproducibility of CIMT measurement in nonsedated infants. Methods: We measured CIMT in 81 infants less than 1 year of age. Repeated measurements were obtained by a second observer in 24 children. The analysis was performed with semiautomated edge detection software. Measurements with over 95% edge detection over a length of 1 cm were considered as valid. We further compared the measurements using the semiautomated method with measurements using the manual electronic caliper method in a subgroup of 10 infants. Results: Carotid ultrasound recordings and intima–media thickness measurements were obtained in 79% of infants (n ¼ 64). Mean CIMT of the 64 infants measured by the first observer was 0.44 mm (SD: 0.04). In the 24 participants with measurements by two observers, the mean interobserver difference was 0.001 mm (SD: 0.026). The interobserver coefficient of variation was 5.9%. CIMT measurements obtained with the manual method (mean: 0.35; range: 0.29–0.39) were slightly lower than measurements obtained with the semiautomated method (mean: 0.38; range: 0.32–0.44). Measurements with both methods were highly correlated (r: 0.87). Conclusion: Measurement of CIMT in nonsedated infants less than 1 year of age is feasible in the majority of infants with good interobserver variability. Keywords: atherosclerosis, carotid artery intima–media thickness, feasibility, infants, reliability Abbreviations: AEPC, Association for European Paediatric Cardiology; BP, blood pressure; CHD, congenital heart disease; CI, confidence interval; CIMT, carotid intima– media thickness INTRODUCTION I t is increasingly recognized that arterial hypertension, obesity, and diabetes have a perinatal origin [1,2]. Studies have indeed shown that a hostile intrauterine environment can lead to metabolic and cardiovascular alterations later in life [3–5]. Hence, children born with intrauterine growth retardation are at increased risk of developing cardiometabolic disorders, including hyperten- sion, in adulthood, especially if they show accelerated catch-up growth in the first years of life [3 – 5]. Among other evidence, this suggests that the process of atherosclerosis starts early in life and progresses over decades leading eventually to cardiovascular disease [6–8]. In adolescents and adults, alterations in vascular function and subclinical atherosclerosis can be observed and precede clinical mani- festations by several years [9 – 11]. Methods to evaluate these parameters in infants are necessary to better understand the roots of the pathogenic process and, eventually, to institute preventive measures. Carotid intima–media thickness (CIMT) is a surrogate marker for atherosclerosis extensively studied in adults [10,11]. It has been shown to be predictive of myocardial infarction, stroke, and peripheral vascular disease [12,13]. In young adults, increased CIMT is associated with various cardiovascular risk factors, notably hypertension [13–15]. Case –control studies have also revealed increased CIMT in children with cardiovascular risk factors such as hyper- tension, hyperlipidemia, diabetes, or early-onset familial coronary heart disease compared with normal pediatric population [16–19]. CIMT has further been used as a primary outcome measure in pediatric clinical trials [19,20]. Nevertheless, there is very limited data on CIMT in children under 5 years of age. It is not known whether Journal of Hypertension 2016, 34:2227–2232 a Pediatric Cardiology, Department of Pediatrics, b Fetal Medicine, Department of Obstetrics and Gynecology and c Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland Correspondence to Nicole Sekarski, MD, Head, Pediatric Cardiology, Department of Pediatrics, Lausanne University Hospital, rue du Bugnon 46, CH-1001 Lausanne, Switzerland. Tel: +41 21 314 35 55; fax: +41 21 314 36 65; e-mail: Nicole.Sekarski@chuv.ch  Yvan Mivelaz and Stefano Di Bernardo contributed equally to the article. Received 17 February 2016 Revised 30 May 2016 Accepted 8 July 2016 J Hypertens 34:2227–2232 Copyright ß 2016 Wolters Kluwer Health, Inc. All rights reserved. DOI:10.1097/HJH.0000000000001065 Journal of Hypertension www.jhypertension.com 2227 Original Article