Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Canada.
Stroke. 2013 Jul;44(7):1859-65. doi: 10.1161/STROKEAHA.113.001461. Epub 2013 Jun 4.
Carotid ultrasound evaluation of intima-media thickness (IMT) and plaque burden has been used for risk stratification and for evaluation of antiatherosclerotic therapies. Increasing evidence indicates that measuring plaque burden is superior to measuring IMT for both purposes. We compared progression/regression of IMT, total plaque area (TPA), and total plaque volume (TPV) as predictors of cardiovascular outcomes.
IMT, TPA, and TPV were measured at baseline in 349 patients attending vascular prevention clinics; they had TPA of 40 to 600 mm(2) at baseline to qualify for enrollment. Participants were followed up for ≤5 years (median, 3.17 years) to ascertain vascular death, myocardial infarction, stroke, and transient ischemic attacks. Follow-up measurements 1 year later were available in 323 cases for IMT and TPA, and in 306 for TPV.
Progression of TPV predicted stroke, death or TIA (Kaplan-Meier logrank P=0.001), stroke/death/MI (P=0.008) and Stroke/Death/TIA/Myocardial infarction (any Cardiovascular event) (P=0.001). Progression of TPA weakly predicted Stroke/Death/TIA (P=0.097) but not stroke/death/MI (P=0.59) or any CV event (P=0.143); likewise change in IMT did not predict Stroke/Death/MI (P=0.13) or any CV event (P=0.455 ). In Cox regression, TPV progression remained a significant predictor of events after adjustment for coronary risk factors (P=0.001) but change in TPA did not. IMT change predicted events in an inverse manner; regression of IMT predicted events (P=0.004).
For assessment of response to antiatherosclerotic therapy, measurement of TPV is superior to both IMT and TPA.
颈动脉超声评估内膜-中层厚度（IMT）和斑块负担已用于风险分层和评估抗动脉粥样硬化治疗。越来越多的证据表明，测量斑块负担对于这两个目的都优于测量 IMT。我们比较了 IMT、总斑块面积（TPA）和总斑块体积（TPV）作为心血管结局的预测指标。
在 349 名参加血管预防诊所的患者中，在基线时测量 IMT、TPA 和 TPV；他们的基线 TPA 在 40 到 600mm²之间，符合入组条件。对参与者进行了最长 5 年（中位数 3.17 年）的随访，以确定血管死亡、心肌梗死、卒中和短暂性脑缺血发作。在 323 例中，有 1 年随访的 IMT 和 TPA 测量值，在 306 例中有 TPV 测量值。
TPV 的进展预测了卒中和死亡或 TIA（卡普兰-迈耶对数秩 P=0.001）、卒中和死亡/心肌梗死（P=0.008）以及卒中和死亡/TIA/心肌梗死（任何心血管事件）（P=0.001）。TPA 的进展也可以预测卒中/死亡/TIA（P=0.097），但不能预测卒中/死亡/心肌梗死（P=0.59）或任何心血管事件（P=0.143）；同样，IMT 的变化也不能预测卒中/死亡/心肌梗死（P=0.13）或任何心血管事件（P=0.455）。在 Cox 回归中，TPV 的进展仍然是在调整冠状动脉危险因素后的事件的显著预测因子（P=0.001），但 TPA 的变化不是。IMT 的变化以相反的方式预测事件；IMT 的回归预测了事件（P=0.004）。
在评估抗动脉粥样硬化治疗的反应时，测量 TPV 优于 IMT 和 TPA。
