Ravani Alessio, Werba Jose Pablo, Frigerio Beatrice, Sansaro Daniela, Amato Mauro, Tremoli Elena, Baldassarre Damiano
Dipartimento di Scienze Farmacologiche e Biomolecolari, Università di Milano, Via Balzaretti 9, 20133, Milan, Italy.
Curr Pharm Des. 2015;21(9):1164-71. doi: 10.2174/1381612820666141013121545.
Interventions aimed to prevent cardiovascular diseases (CVD) are more effective if administered to subjects carefully selected according to their CVD risk. Usually, this risk is evaluated on the basis of the presence and severity of conventional vascular risk factors (VRFs); however, atherosclerosis, the main pathologic substrate of CVD, is not directly revealed by VRFs. The measurement of the arterial wall, using imaging techniques, has increased the early identification of individuals prone to develop atherosclerosis and to quantify its changes over time. B-mode ultrasound is a technique which allows a non-invasive assessment of the arterial wall of peripheral arteries (e.g. extracranial carotid arteries), and provides measures of the intima-media thickness complex (C-IMT) and additional data on the occurrence, localization and morphology of plaques. Being an independent predictor of vascular events, C-IMT has been considered as a tool to optimize the estimation of CVD risk but this application is still a matter of debate. Though the technique is innocuous, relatively inexpensive and repeatable, its use in the clinical practice is limited by the lack of standardized protocols and clear guidelines. This review outlines the rationale for the potential use of C-IMT in the stratification of cardio- and cerebro-vascular risk and discusses several topics related to the measurement of this variable, which are still controversial among experts of the field.
如果针对根据心血管疾病（CVD）风险精心挑选的受试者进行干预，预防心血管疾病会更有效。通常，这种风险是根据传统血管危险因素（VRF）的存在情况和严重程度来评估的；然而，动脉粥样硬化作为心血管疾病的主要病理基础，并未由血管危险因素直接揭示。利用成像技术测量动脉壁，提高了对易患动脉粥样硬化个体的早期识别能力，并能对其随时间的变化进行量化。B型超声是一种可对外周动脉（如颅外颈动脉）的动脉壁进行无创评估的技术，可提供内膜中层厚度复合体（C-IMT）的测量值以及有关斑块的发生、定位和形态的额外数据。作为血管事件的独立预测指标，C-IMT被视为优化心血管疾病风险评估的一种工具，但这种应用仍存在争议。尽管该技术无害、相对便宜且可重复，但由于缺乏标准化方案和明确指南，其在临床实践中的应用受到限制。本综述概述了C-IMT在心血管和脑血管风险分层中潜在应用的基本原理，并讨论了与该变量测量相关的几个话题，这些话题在该领域的专家中仍存在争议。
