颈动脉斑块负荷作为亚临床动脉粥样硬化的衡量指标：在高危斑块生物图像研究中与其他亚临床动脉疾病检测方法的比较。
Carotid plaque burden as a measure of subclinical atherosclerosis: comparison with other tests for subclinical arterial disease in the High Risk Plaque BioImage study.
机构信息
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
出版信息
JACC Cardiovasc Imaging. 2012 Jul;5(7):681-9. doi: 10.1016/j.jcmg.2012.03.013.
OBJECTIVES
The purpose of this study was to compare carotid plaque burden, carotid intima-media thickness (cIMT), ankle-brachial index (ABI), and abdominal aortic diameter (AAD) to coronary artery calcium score (CACS) in people without known cardiovascular disease.
BACKGROUND
The clinical utility of risk factors to predict cardiovascular events is limited. Detection of subclinical atherosclerosis by noninvasive tests such as CACS, cIMT, carotid plaque burden, AAD, and ABI may improve risk prediction above that of established risk scoring models, namely, Framingham Risk Score.
METHODS
The High Risk Plaque BioImage study investigated 6.101 asymptomatic persons and reports baseline CACS, cIMT, ABI, and AAD. In addition, we present findings from a new 3-dimensional-based ultrasound approach, where the carotid artery was investigated in cross section from proximal in the neck to as distal as possible. From the resulting 10-s video, plaque was outlined on cross-sectional images and all plaque areas were summarized into "plaque burden."
RESULTS
The mean age was 68.8 years, and 65.3% of subjects had intermediate Framingham Risk Score (6% to 20% 10-year risk). Carotid plaques were identified in 78% of cases, abnormal ABI in 10%, AAD >20 mm in 28%, and coronary calcium in 68% of participants. Carotid plaque burden was found to correlate stronger with CACS (chi-square 450, p < 0.0001) than did cIMT (chi-square 24, p < 0.0001), AAD (chi-square 2.9, p = 0.091), and ABI (chi-square 35.2, p < 0.0001).
CONCLUSIONS
In the BioImage study, a new 3-dimensional-based ultrasound method identified more carotid plaques than in previous studies. Compared to other methods, carotid plaque burden was the strongest cross-sectional predictor of CACS, and its clinical utility as predictor of future cardiovascular events is being evaluated in the BioImage study. (BioImage Study: A Clinical Study of Burden of Atherosclerotic Disease in an At-Risk Population; NCT00738725).
目的
本研究旨在比较颈动脉斑块负担、颈动脉内膜中层厚度（cIMT）、踝臂指数（ABI）和腹主动脉直径（AAD）与冠状动脉钙评分（CACS）在无已知心血管疾病的人群中的差异。
背景
危险因素预测心血管事件的临床实用性有限。通过 CACS、cIMT、颈动脉斑块负担、AAD 和 ABI 等非侵入性检查检测亚临床动脉粥样硬化，可能会提高风险预测的准确性，超越现有的风险评分模型，如 Framingham 风险评分。
方法
高风险斑块生物影像研究调查了 6101 名无症状个体，报告了基线 CACS、cIMT、ABI 和 AAD。此外，我们还介绍了一种新的基于 3 维的超声方法的研究结果，该方法从颈部近端到尽可能远的位置对颈动脉进行横断面检查。从 10 秒的视频中，在横断图像上勾画斑块，并将所有斑块面积总结为“斑块负担”。
结果
平均年龄为 68.8 岁，65.3%的受试者 Framingham 风险评分处于中等水平（6%至 20%的 10 年风险）。78%的病例发现颈动脉斑块，10%的病例 ABI 异常，28%的病例 AAD>20mm，68%的参与者有冠状动脉钙。与 cIMT（卡方 24，p<0.0001）、AAD（卡方 2.9，p=0.091）和 ABI（卡方 35.2，p<0.0001）相比，颈动脉斑块负担与 CACS 的相关性更强（卡方 450，p<0.0001）。
结论
在 BioImage 研究中，一种新的基于 3 维的超声方法比以前的研究发现了更多的颈动脉斑块。与其他方法相比，颈动脉斑块负担是 CACS 的最强的横断面对照预测因子，其作为未来心血管事件预测因子的临床实用性正在 BioImage 研究中进行评估。（BioImage 研究：高危人群动脉粥样硬化疾病负担的临床研究；NCT00738725）。
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