Proietti Marco, Calvieri Camilla, Malatino Lorenzo, Signorelli Santo, Corazza Gino Roberto, Perticone Francesco, Vestri Anna Rita, Loffredo Lorenzo, Davì Giovanni, Violi Francesco, Basili Stefania
I Clinica Medica, Sapienza-University of Rome, Italy.
Clinica Medica e Centro Ipertensione, Ospedale Cannizzaro, University of Catania, Catania, Italy.
Atherosclerosis. 2015 Feb;238(2):350-5. doi: 10.1016/j.atherosclerosis.2014.12.022. Epub 2014 Dec 20.
Carotid intima-media thickness (cIMT) is a surrogate marker of subclinical atherosclerosis and it is able to predict both coronary and cerebral vascular events. No data exist on the association between cIMT and non valvular atrial fibrillation (NVAF) type. We conduct this study with the aim to analyze the association between abnormal cIMT and NVAF type.
A cross-sectional study of the "Atrial fibrillation Registry for Ankle-brachial index Prevalence Assessment-Collaborative Italian Study (ARAPACIS)" has been performed. Among 2027 patients enrolled in the ARAPACIS, 673 patients, who underwent carotid ultrasound examination to assess cIMT, were included in the study.
Among the entire population, 478 patients (71%) had cIMT > 0.90 mm. Patients with an abnormal cIMT (>0.90 mm) were significantly older and more likely hypertensive, diabetic and with a previous history of stroke than those with normal cIMT (≤0.90 mm). These patients had more permanent/persistent NVAF and CHA2DS2-VASc score ≥ 2 (p < 0.0001) compared to those with cIMT <0.90 mm. Excluding all patients affected by previous cardiovascular disease, logistic regression analysis showed that independent predictors of abnormal cIMT were: age class 65-74 yrs. (p < 0.001), age class ≥75 yrs. (p < 0.001), arterial hypertension (p < 0.001), calcium-channel blockers use (p < 0.001) and persistent/permanent NVAF (p = 0.001).
Our findings show a high prevalence of abnormal cIMT in NVAF patients, reinforcing the concept that NVAF and systemic atherosclerosis are closely associated. Abnormal cIMT was particularly evident in persistent/permanent NVAF suggesting a more elevated atherosclerotic burden in patients with long-standing NVAF.
颈动脉内膜中层厚度（cIMT）是亚临床动脉粥样硬化的替代标志物，能够预测冠状动脉和脑血管事件。目前尚无关于cIMT与非瓣膜性心房颤动（NVAF）类型之间关联的数据。我们开展本研究旨在分析异常cIMT与NVAF类型之间的关联。
进行了一项关于“踝臂指数患病率评估心房颤动登记协作意大利研究（ARAPACIS）”的横断面研究。在ARAPACIS登记的2027例患者中，673例接受了颈动脉超声检查以评估cIMT的患者被纳入研究。
在整个人口中，478例患者（71%）的cIMT>0.90mm。与cIMT正常（≤0.90mm）的患者相比，cIMT异常（>0.90mm）的患者年龄更大，更有可能患有高血压、糖尿病且有中风病史。与cIMT<0.90mm的患者相比，这些患者有更多的永久性/持续性NVAF且CHA2DS2-VASc评分≥2（p<0.0001）。排除所有既往有心血管疾病的患者后，逻辑回归分析显示cIMT异常的独立预测因素为：65 - 74岁年龄组（p<0.001）、≥75岁年龄组（p<0.001）、动脉高血压（p<0.001）、使用钙通道阻滞剂（p<0.001）和持续性/永久性NVAF（p = 0.001）。
我们的研究结果显示NVAF患者中cIMT异常的患病率很高，强化了NVAF与全身性动脉粥样硬化密切相关的概念。cIMT异常在持续性/永久性NVAF中尤为明显，表明长期NVAF患者的动脉粥样硬化负担更高。
