Sillesen Henrik, Fuster Valentin
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Mt Sinai J Med. 2012 Nov-Dec;79(6):654-63. doi: 10.1002/msj.21343.
Atherosclerosis is the leading cause of death and disabling disease. Whereas risk factors are well known and constitute therapeutic targets, they are not useful for prediction of risk of future myocardial infarction, stroke, or death. Therefore, methods to identify atherosclerosis itself have been tested and found useful (ie, coronary calcium detection by computed tomography scanning, reduction in ankle-brachial index, and ultrasound scanning of the carotid arteries). This review will focus on the latter technique. Detection of thickened carotid intima-media by ultrasound has been used in many large epidemiological studies, but although it has been found to be associated with increased risk of cardiovascular death, its clinical utility is limited. Detection of carotid plaque has, on the other hand, been found to be associated with a substantial risk of future events. Similarly, detection of plaque in the femoral arteries is associated with increased risk, and plaque in the femoral as well as carotid arteries predicts even higher risk. Furthermore, quantification of plaque size (plaque area), such as quantification of amount of coronary calcium on computed tomography scanning, improves predictability-the larger the plaques, the higher the risk. So far, studies using ultrasound all have been performed with 2-dimensional ultrasound imaging. Recently, 3-dimensional ultrasound imaging has been introduced, which allows for more accurate quantification of atherosclerosis. Small studies pioneering its use have indicated the utility of measuring changes in vessel-wall volume and plaque volume with respect to treatment effect. The High-Risk Plaque Initiative BioImage Study is currently investigating the predictive value of total carotid plaque volume with respect to prediction of future cardiovascular events.
动脉粥样硬化是导致死亡和致残性疾病的主要原因。虽然已知风险因素并构成治疗靶点，但它们对于预测未来心肌梗死、中风或死亡的风险并无用处。因此，已对识别动脉粥样硬化本身的方法进行了测试并发现其有用（即通过计算机断层扫描检测冠状动脉钙化、测量踝臂指数降低情况以及对颈动脉进行超声扫描）。本综述将聚焦于后一种技术。通过超声检测颈动脉内膜中层增厚已在许多大型流行病学研究中得到应用，但尽管已发现其与心血管死亡风险增加相关，但其临床实用性有限。另一方面，已发现检测颈动脉斑块与未来事件的重大风险相关。同样，检测股动脉斑块也与风险增加相关，股动脉和颈动脉中的斑块预示着更高的风险。此外，对斑块大小（斑块面积）进行量化，如在计算机断层扫描上对冠状动脉钙化量进行量化，可提高预测能力——斑块越大，风险越高。到目前为止，所有使用超声的研究均采用二维超声成像进行。最近，三维超声成像已被引入，它能够更准确地对动脉粥样硬化进行量化。率先使用它的小型研究表明了测量血管壁体积和斑块体积变化对于治疗效果的实用性。高危斑块倡议生物图像研究目前正在调查总颈动脉斑块体积对未来心血管事件预测的价值。
