Speckle-tracking carotid strain ultrasonography for assessment of vascular dysfunction in metabolic syndrome: a cross-sectional study

Abstract Background Metabolic syndrome (MetS) is associated with increased cardiovascular risk, which rises with the number of MetS components. Conventional carotid ultrasound markers may not fully characterize dynamic arterial wall mechanics, whereas speckle-tracking carotid strain ultrasonography (STCS-US) enables integrated assessment of carotid stiffness and deformation throughout the cardiac cycle. This study aimed to assess multidimensional carotid mechanics in individuals with MetS and their association with cumulative metabolic burden. Methods This retrospective cross-sectional study included 100 participants:50 patients with MetS diagnosed according to the National Cholesterol Education ProgramAdult Treatment Panel III (ATP III) criteria and 50 age and sex matched controls without MetS Carotid Doppler US images were analyzed using the Arterial Analysis software program, which quantified 22 vascular parameters per participant, comprising five stiffness parameters (β-stiffness index [β-SI], arterial compliance [AC], arterial distensibility [AD], elastic modulus [EM], and pulse wave velocity [PWV]) and six strain parameters (radial strain, radial displacement [DP], radial strain rate [SR], circumferential strain, circumferential displacement, and circumferential strain rate), each obtained in both the longitudinal and transverse planes. Correlations between the number of MetS components and imaging-derived vascular parameters were analyzed. Classification and Regression Trees (CART) analysis was performed to evaluate the relative contribution of clinical and structural variables to STCS-US-derived vascular parameters. Results Patients with MetS exhibited significantly increased stiffness parameters, including EM and PWV, and reduced compliance indices compared with controls (all p < 0.05). Strain analysis demonstrated significantly lower radial and circumferential strain percentages in the MetS group, with more pronounced alterations observed in the transverse plane (all p < 0.001). Increasing MetS component count was associated with higher stiffness indices and lower strain values. CART analysis demonstrated that MetS status remained one of the most important determinants across the reported STCS-US-derived vascular parameters. Conclusion STCS-US revealed coordinated impairment in carotid arterial stiffness and strain parameters in MetS, particularly in the transverse plane. These findings suggest that STCS-US may provide complementary functional information alongside conventional stiffness assessment and may reflect the cumulative metabolic burden on vascular mechanics.