Ultrasound Reading Center, Department of Radiology, Tufts Medical Center, Boston, MA 02111, USA.
J Am Heart Assoc. 2013 Apr 8;2(2):e000087. doi: 10.1161/JAHA.113.000087.
Carotid artery plaques are associated with coronary artery atherosclerotic lesions. We evaluated various ultrasound definitions of carotid artery plaque as predictors of future cardiovascular disease (CVD) and coronary heart disease (CHD) events.
We studied the risk factors and ultrasound measurements of the carotid arteries at baseline of 6562 members (mean age 61.1 years; 52.6% women) of the Multi-Ethnic Study of Atherosclerosis (MESA). ICA lesions were defined subjectively as >0% or ≥25% diameter narrowing, as continuous intima-media thickness (IMT) measurements (maximum IMT or the mean of the maximum IMT of 6 images) and using a 1.5-mm IMT cut point. Multivariable Cox proportional hazards models were used to estimate hazard ratios for incident CVD, CHD, and stroke. Harrell's C-statistics, Net Reclassification Improvement, and Integrated Discrimination Improvement were used to evaluate the incremental predictive value of plaque metrics. At 7.8-year mean follow-up, all plaque metrics significantly predicted CVD events (n=515) when added to Framingham risk factors. All except 1 metric improved the prediction of CHD (by C-statistic, Net Reclassification Improvement, and Integrated Discrimination Improvement. Mean of the maximum IMT had the highest NRI (7.0%; P=0.0003) with risk ratio of 1.43/mm; 95% CI 1.26-1.63) followed by maximum IMT with an NRI of 6.8% and risk ratio of 1.27 (95% CI 1.18-1.38).
Ultrasound-derived plaque metrics independently predict cardiovascular events in our cohort and improve risk prediction for CHD events when added to Framingham risk factors.
颈动脉斑块与冠状动脉粥样硬化性病变有关。我们评估了颈动脉斑块的各种超声定义，作为未来心血管疾病（CVD）和冠心病（CHD）事件的预测指标。
我们研究了 6562 名多民族动脉粥样硬化研究（MESA）参与者的基线颈动脉危险因素和超声测量值（平均年龄 61.1 岁；52.6%为女性）。ICA 病变根据主观定义为>0%或≥25%的直径狭窄，连续内膜中层厚度（IMT）测量（最大 IMT 或 6 个图像最大 IMT 的平均值）和使用 1.5mm IMT 切点。多变量 Cox 比例风险模型用于估计事件性 CVD、CHD 和中风的风险比。Harrell 的 C 统计量、净重新分类改善和综合鉴别改善用于评估斑块指标的增量预测值。在 7.8 年的平均随访中，当加入 Framingham 危险因素时，所有斑块指标均显著预测 CVD 事件（n=515）。除 1 项指标外，所有指标均改善了 CHD 的预测（通过 C 统计量、净重新分类改善和综合鉴别改善）。最大 IMT 平均值的 NRI 最高（7.0%；P=0.0003），风险比为 1.43/mm；95%CI 为 1.26-1.63），其次是最大 IMT，NRI 为 6.8%，风险比为 1.27（95%CI 为 1.18-1.38）。
在我们的队列中，超声衍生的斑块指标独立预测心血管事件，并在加入Framingham 危险因素后改善 CHD 事件的风险预测。
