老年男性高血压高危人群中冠状动脉钙化积分与主动脉直径的相关性
Correlation between coronary artery calcium score and aortic diameter in a high-risk population of elderly male hypertensive patients.
作者信息
Cho In-Jeong, Heo Ran, Chang Hyuk-Jae, Shin Sanghoon, Shim Chi Young, Hong Geu-Ru, Min James K, Chung Namsik
机构信息
aDivision of Cardiology, Department of Internal Medicine, Severance Hospital bSeverance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea and Departments of cRadiology dMedicine, Weill Cornell Medical College and the New York-Presbyterian Hospital, New York, New York, USA.
出版信息
Coron Artery Dis. 2014 Dec;25(8):698-704. doi: 10.1097/MCA.0000000000000150.
BACKGROUND
Studies on the relationship between coronary artery calcium and aortic diameter are scarce. The aim of the current study was to evaluate the correlation between coronary artery calcium score (CACS) and maximal thoracic and abdominal aortic diameters in a population of elderly (>65 years) male hypertensive patients at high risk for coronary artery disease.
PATIENTS AND METHODS
From June 2012 to April 2013, we prospectively enrolled 393 male hypertensive patients older than 65 years of age who had no history of aortic aneurysm. Coronary artery calcium and maximal diameters of the ascending thoracic aorta (ATAmax), descending thoracic aorta (DTAmax), and abdominal aorta (AAmax) were measured using noncontrast computed tomography imaging. Aortic diameters are indexed to body surface area (BSA). Participants were divided into five groups according to CACS (0, 1-10, 10-100, 100-400, and >400).
RESULTS
The mean ATAmax/BSA, DTAmax/BSA, and AAmax/BSA were 22.0±2.7, 16.3±1.9, and 13.0±2.9 mm, respectively. On multivariate analysis, ATAmax/BSA was associated independently with age, diabetes, and history of aortic valve replacement (all P<0.001). DTAmax/BSA was associated independently with age (P<0.001). However, there were no significant correlations between thoracic aorta diameter and CACS. In contrast, AAmax/BSA was associated independently with CACS as well as age and history of smoking (P=0.014, 0.003, and 0.019, respectively). Abdominal aortic aneurysm (>30 mm) was more prevalent in patients with a CACS of 400 or more compared with the others (14 vs. 3%, P<0.001).
CONCLUSION
CACS was associated with increased abdominal aorta diameter, but not with thoracic aorta diameter. Therefore, screening for an abdominal aortic aneurysm is warranted in patients with a high risk of coronary artery disease and a high CACS. However, the necessity for thoracic aortic aneurysm screening is not clear in these patients.
背景
关于冠状动脉钙化与主动脉直径之间关系的研究较少。本研究的目的是评估在老年（>65岁）男性高血压且患冠状动脉疾病风险较高的人群中，冠状动脉钙化评分（CACS）与胸主动脉和腹主动脉最大直径之间的相关性。
患者与方法
2012年6月至2013年4月，我们前瞻性纳入了393名年龄大于65岁且无主动脉瘤病史的男性高血压患者。使用非增强计算机断层扫描成像测量冠状动脉钙化以及升主动脉（ATAmax）、降主动脉（DTAmax）和腹主动脉（AAmax）的最大直径。主动脉直径以体表面积（BSA）进行指数化。参与者根据CACS分为五组（0、1 - 10、10 - 100、100 - 400和>400）。
结果
平均ATAmax/BSA、DTAmax/BSA和AAmax/BSA分别为22.0±2.7、16.3±1.9和13.0±2.9mm。多因素分析显示，ATAmax/BSA独立与年龄、糖尿病和主动脉瓣置换史相关（均P<0.001）。DTAmax/BSA独立与年龄相关（P<0.001）。然而，胸主动脉直径与CACS之间无显著相关性。相反，AAmax/BSA独立与CACS以及年龄和吸烟史相关（分别为P = 0.014、0.003和0.019）。与其他患者相比，CACS为400或更高的患者腹主动脉瘤（>30mm）更为常见（14%对3%，P<0.001）。
结论
CACS与腹主动脉直径增加相关，但与胸主动脉直径无关。因此，对于冠状动脉疾病风险高且CACS高的患者，有必要筛查腹主动脉瘤。然而，这些患者中筛查胸主动脉瘤的必要性尚不清楚。
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