Belcaro G, Nicolaides A N, Ramaswami G, Cesarone M R, De Sanctis M, Incandela L, Ferrari P, Geroulakos G, Barsotti A, Griffin M, Dhanjil S, Sabetai M, Bucci M, Martines G
Department of Biomedical Sciences and Cardiology School, Chieti University, Chieti, Italy.
Atherosclerosis. 2001 Jun;156(2):379-87. doi: 10.1016/s0021-9150(00)00665-1.
Subclinical arteriosclerotic lesions at the carotid and femoral bifurcations may be related to the occurrence of future cardiovascular events and of occult arteriosclerotic coronary disease. B-mode ultrasound of carotid and femoral arteriosclerotic bifurcation lesions may provide a simple screening method to select asymptomatic subjects at risk of future events.
13221 low-risk, healthy, asymptomatic individuals were included in a 10-year, prospective, follow-up based on carotid and femoral bifurcation morphology defined by B-mode ultrasound. Four classes were considered at inclusion (I: normal wall, II: wall thickening, III: non-stenosing plaques, IV: stenosing plaques). When 10000 subjects (75.6% of included subjects; 6055 males, 3945 females) completed the 10-year follow-up the study was concluded. At 10 years there were 10 events (out of 7989 subjects) in class I and 81 events in II (930 subjects; incidence=8.6%); 239 events were observed in class III (611 subjects; 39.28%) and 381 events (470 subjects; 81.06%) in IV; 61 deaths occurred in classes III+IV (1081 subjects) producing a death rate within these two classes of 5.5% (51 out of 61=81.5% in class IV). The increased event rates in classes III and IV were significant (log rank; P<0.02) in comparison with I and II.
Carotid and femoral morphology identified 2011 subjects (20.1% of the population) in classes II,III,IV including 98.6% of cardiovascular events and deaths in the following 10 years. A higher (P<0.05) rate of progression in classes III and IV in comparison with I and II was also observed. The ultrasound carotid and femoral classification was useful in selecting subjects at very low risk of cardiovascular events (class I), those at limited risk (class II) and a group at moderate risk (class III). A subpopulation at high risk of cardiovascular events (IV) was identified.
颈动脉和股动脉分叉处的亚临床动脉粥样硬化病变可能与未来心血管事件及隐匿性动脉粥样硬化性冠状动脉疾病的发生有关。对颈动脉和股动脉分叉处病变进行B型超声检查可为筛选未来有发病风险的无症状个体提供一种简单的方法。
13221名低风险、健康、无症状个体被纳入一项基于B型超声所定义的颈动脉和股动脉分叉形态的为期10年的前瞻性随访研究。纳入时分为四类（I：管壁正常；II：管壁增厚；III：非狭窄性斑块；IV：狭窄性斑块）。当10000名受试者（占纳入受试者的75.6%；男性6055名，女性3945名）完成10年随访时，研究结束。10年后，I类中有10例事件（共7989名受试者），II类中有81例事件（930名受试者；发病率=8.6%）；III类中观察到239例事件（611名受试者；39.28%），IV类中有381例事件（470名受试者；81.06%）；III+IV类中有61例死亡（1081名受试者），这两类的死亡率为5.5%（61例中的51例=IV类中的81.5%）。与I类和II类相比，III类和IV类中事件发生率的增加具有显著性（对数秩检验；P<0.02）。
颈动脉和股动脉形态确定了2011名处于II、III、IV类的受试者（占总人群的20.1%），其中包括接下来10年中98.6%的心血管事件和死亡病例。还观察到与I类和II类相比，III类和IV类的进展率更高（P<0.05）。超声对颈动脉和股动脉的分类有助于筛选心血管事件极低风险的受试者（I类）、风险有限的受试者（II类）以及中度风险的一组受试者（III类）。确定了一个心血管事件高风险的亚组（IV类）。
