Angiology and Intensive Care Unit, Third Department of Medicine, University of Debrecen Medical and Health Sciences Center, 98 Nagyerdei Street, Debrecen H-4032, Hungary.
Nat Rev Rheumatol. 2012 Feb 21;8(4):224-34. doi: 10.1038/nrrheum.2012.16.
Rheumatoid arthritis, as well as other types of arthritides and connective tissue diseases, is associated with accelerated atherosclerosis, and increased cardiovascular morbidity and mortality. The early signs of cardiovascular disease therefore need to be recognized in patients with these conditions so that effective cardiovascular protection can be introduced. This Review provides an overview of validated techniques that are currently available to determine subclinical atherosclerosis in patients with rheumatic conditions. Techniques for early assessment of endothelial dysfunction include brachial artery flow-mediated vasodilation and laser Doppler flowmetry. Coronary circulation can be assessed by measuring coronary flow reserve using CT, MRI or PET based techniques. The standard indicators of arterial stiffness are pulse-wave velocity and the augmentation index. Carotid atherosclerosis is determined by the common carotid intima-media thickness (ccIMT) measurement or by the assessment of plaques and plaque areas. The combination of ccIMT with plaque assessment is likely to increase the predictive value of this approach. The potential use of a multimarker approach to increase the diagnostic and prognostic value of these clinical assessments is also discussed.
类风湿关节炎和其他类型的关节炎及结缔组织疾病与动脉粥样硬化加速、心血管发病率和死亡率增加相关。因此，需要在这些疾病患者中识别心血管疾病的早期迹象，以便能够引入有效的心血管保护措施。这篇综述概述了目前可用于确定风湿性疾病患者亚临床动脉粥样硬化的经过验证的技术。用于早期评估内皮功能障碍的技术包括肱动脉血流介导的血管扩张和激光多普勒流量测定。可以通过 CT、MRI 或基于 PET 的技术测量冠状动脉血流储备来评估冠状动脉循环。动脉僵硬度的标准指标是脉搏波速度和增强指数。颈动脉粥样硬化通过颈总动脉内膜中层厚度（ccIMT）测量或斑块和斑块面积评估来确定。ccIMT 与斑块评估相结合可能会增加这种方法的预测价值。还讨论了使用多标志物方法来提高这些临床评估的诊断和预后价值的可能性。
