Department of Internal Medicine, Cardiovascular Sciences and Immunology, Federico II University of Naples, Via Pansini, 5, 80131, Napoli, Italy.
Eur Heart J. 2011 Aug;32(16):1986-93, 1993a, 1993b. doi: 10.1093/eurheartj/ehq235. Epub 2010 Jul 14.
Cardiovascular events remain one of the most frequent causes of mortality and morbidity worldwide. The majority of cardiac events occur in individuals without known coronary artery disease (CAD) and in low- to intermediate-risk subjects. Thus, the development of improved preventive strategies may substantially benefit from the identification, among apparently intermediate-risk subjects, of those who have a high probability for developing future cardiac events. Cardiac computed tomography and myocardial perfusion scintigraphy (MPS) by single photon emission computed tomography may play a role in this setting. In fact, absence of coronary calcium in cardiac computed tomography and inducible ischaemia in MPS are associated with a very low rate of major cardiac events in the next 3-5 years. Based on current evidence, the evaluation of coronary calcium in primary prevention subjects should be considered in patients classified as intermediate-risk based on traditional risk factors, since high calcium scores identify subjects at high-risk who may benefit from aggressive secondary prevention strategies. In addition, calcium scoring should be considered for asymptomatic type 2 diabetic patients without known CAD to select those in whom further functional testing by MPS or other stress imaging techniques may be considered to identify patients with significant inducible ischaemia. From available data, the use of MPS as first line testing modality for risk stratification is not recommended in any category of primary prevention subjects with the possible exception of first-degree relatives of patients with premature CAD in whom MPS may be considered. However, the Working Group recognizes that neither the use of computed tomography for calcium imaging nor of MPS have been proven to significantly improve clinical outcomes of primary prevention subjects in prospective controlled studies. This information would be crucial to adequately define the role of imaging approaches in cardiovascular preventive strategies.
心血管事件仍然是全球范围内最常见的死亡和发病原因之一。大多数心脏事件发生在没有已知冠状动脉疾病 (CAD) 的个体和低至中危人群中。因此，在看似中危的人群中，确定那些有高概率发生未来心脏事件的人，可能会大大受益于开发更好的预防策略。心脏计算机断层扫描和单光子发射计算机断层扫描心肌灌注显像 (MPS) 可能在这种情况下发挥作用。事实上，心脏计算机断层扫描中无冠状动脉钙和 MPS 中的诱发性缺血与未来 3-5 年内发生重大心脏事件的低发生率相关。基于目前的证据，应考虑在基于传统危险因素分类为中危的患者中评估初级预防患者的冠状动脉钙，因为高钙分数可识别高危患者，这些患者可能受益于积极的二级预防策略。此外，对于没有已知 CAD 的无症状 2 型糖尿病患者，应考虑进行钙评分，以选择进一步进行 MPS 或其他应激成像技术的功能测试，以识别有明显诱发性缺血的患者。根据现有数据，不建议将 MPS 作为任何一级预防患者的一线风险分层测试方法，可能的例外是早发 CAD 患者的一级亲属，在这些患者中可以考虑使用 MPS。然而，工作组认识到，在前瞻性对照研究中，使用计算机断层扫描进行钙成像或 MPS 均未证明可显著改善一级预防患者的临床结局。这些信息对于充分确定影像学方法在心血管预防策略中的作用至关重要。
