Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.
Circ Cardiovasc Imaging. 2011 Jan;4(1):8-15. doi: 10.1161/CIRCIMAGING.110.959403. Epub 2010 Nov 10.
Coronary artery calcium (CAC), carotid intima-media thickness, and left ventricular (LV) mass and geometry offer the potential to characterize incident cardiovascular disease (CVD) risk in clinically asymptomatic individuals. The objective of the study was to compare these cardiovascular imaging measures for their overall and sex-specific ability to predict CVD.
The study sample consisted of 4965 Multi-Ethnic Study of Atherosclerosis participants (48% men; mean age, 62±10 years). They were free of CVD at baseline and were followed for a median of 5.8 years. There were 297 CVD events, including 187 coronary heart disease (CHD) events, 65 strokes, and 91 heart failure (HF) events. CAC was most strongly associated with CHD (hazard ratio [HR], 2.3 per 1 SD; 95% CI, 1.9 to 2.8) and all CVD events (HR, 1.7; 95% CI, 1.5 to 1.9). Most strongly associated with stroke were LV mass (HR, 1.3; 95% CI, 1.1 to 1.7) and LV mass/volume ratio (HR, 1.3; 95% CI, 1.1 to 1.6). LV mass showed the strongest association with HF (HR, 1.8; 95% CI, 1.6 to 2.1). There were no significant interactions for imaging measures with sex and ethnicity for any CVD outcome. Compared with traditional risk factors alone, overall risk prediction (C statistic) for future CHD, HF, and all CVD was significantly improved by adding CAC, LV mass, and CAC, respectively (all P<0.05).
There was no evidence that imaging measures differed in association with incident CVD by sex. CAC was most strongly associated with CHD and CVD; LV mass and LV concentric remodeling best predicted stroke; and LV mass best predicted HF.
冠状动脉钙（CAC）、颈动脉内膜中层厚度以及左心室（LV）质量和几何结构有潜力用于描述临床无症状个体的心血管疾病（CVD）风险。本研究的目的是比较这些心血管成像指标在整体和性别特异性方面预测 CVD 的能力。
研究样本包括 4965 名动脉粥样硬化多民族研究（Multi-Ethnic Study of Atherosclerosis，MESA）参与者（48%为男性；平均年龄 62±10 岁）。他们在基线时无 CVD 病史，并随访中位数为 5.8 年。共发生 297 例 CVD 事件，包括 187 例冠心病（CHD）事件、65 例卒中和 91 例心力衰竭（HF）事件。CAC 与 CHD（风险比 [HR]，每 1SD 增加 2.3；95%置信区间 [CI]，1.9 至 2.8）和所有 CVD 事件（HR，1.7；95%CI，1.5 至 1.9）的相关性最强。与卒中相关性最强的是 LV 质量（HR，1.3；95%CI，1.1 至 1.7）和 LV 质量/容积比（HR，1.3；95%CI，1.1 至 1.6）。LV 质量与 HF（HR，1.8；95%CI，1.6 至 2.1）的相关性最强。对于任何 CVD 结局，成像指标与性别和种族之间均无显著交互作用。与单独的传统危险因素相比，分别加入 CAC、LV 质量和 CAC 后，未来 CHD、HF 和所有 CVD 的总体风险预测（C 统计量）均显著提高（均 P<0.05）。
没有证据表明成像指标与 CVD 事件的相关性因性别而异。CAC 与 CHD 和 CVD 的相关性最强；LV 质量和 LV 向心性重构对卒中的预测最佳；而 LV 质量对 HF 的预测最佳。
