Moreo Antonella, Gaibazzi Nicola, Faggiano Pompilio, Mohammed Moemen, Carerj Scipione, Mureddu Gianfrancesco, Pigazzani Filippo, Muiesan Lorenza, Salvetti Massimo, Cesana Francesca, Faden Giacomo, Facchetti Rita, Giannattasio Cristina, Rigo Fausto
aCardiology IV, Department 'A De Gasperis', Ospedale Niguarda Ca'Granda, Milano bDepartment of Health Science, University of Milano-Bicocca, Milano cDepartment of Cardiology, Parma University Hospital, Parma dDivision of Cardiology, Spedali Civili, University of Brescia, Brescia eDepartment of Cardiology, Clinical and Experimental Medicine, University of Messina, Messina fEcho-Lab and Cardiovascular Prevention Unit, San Giovanni-Addolorata Hospital, Roma gDepartment of Clinical and Experimental Sciences, Medicina Spedali Civili, and University of Brescia, Brescia hDepartment of Cardiology, dell'Angelo Hospital, Mestre-Venice, Italy.
J Hypertens. 2015 Jun;33(6):1291-300. doi: 10.1097/HJH.0000000000000543.
Cardiovascular risk prediction is deemed fundamental and the assessment of organ damage is emerging as a potentially 'downstream' picture of individual risk. Our aim was to assess the feasibility and value of prediction of coronaropathy [coronary artery disease (CAD)] of integrated cardiovascular ultrasound examination.
This multicenter study involved eight cardiology centers that enrolled 457 consecutive patients. Blood pressures, carotid intima-media thickness (cIMT), carotid pulse wave velocity (cPWV), semiquantitative score of cardiac calcifications, global myocardial longitudinal strain (GLS), and rest Doppler flow velocity on the left anterior descending (LAD) coronary artery were measured. After coronary angiography, patients were divided in CAD, n = 273, at least one coronary stenosis higher than 50%, and no CAD, n = 184.
CAD were older (65.9 ± 10.7 versus 63.1 ± 11.2 years, mean ± standard deviation, P = 0.01), and had higher blood pressure (137.0 ± 18.8/77.5 ± 11.1 versus 130.2 ± 17.4/75.1 ± 9.7 mmHg, P < 0.02), cIMT (791.4 ± 165.5 versus 712.0 ± 141.5 mcm, P < 0.0001), cPWV (median: 9 versus 8.1 m/s, P < 0.01), score of calcium (median, 2 versus 1, P < 0.0001), LAD velocity (median, 38 versus 36, P < 0.07), and lower GLS (-17.6 ± 4.3 versus -19.3 ± 5.1, P < 0.05) than no CAD. Score of calcium was feasible in the totality of patients, cIMT in 97%, cPWV in 86%, GLS in 88%, and LAD in 84%. A combination of at least three variables was measurable in 80% of the patients. All ultrasound parameters significantly predicted CAD. However, in a stepwise logistic regression, the only combined predictors of obstructive CAD were score of calcium, cIMT, and LAD velocity.
In Echo-Lab, Rome, Italy, the integrated cardiovascular ultrasound study is feasible in a high percentage of patients. The combination of three parameters, that is, score of calcium, cIMT, and LAD velocity, has incremental predictive value for obstructive CAD.
心血管风险预测被视为基础，而器官损害评估正逐渐成为个体风险的潜在“下游”图景。我们的目的是评估综合心血管超声检查预测冠心病[冠状动脉疾病（CAD）]的可行性和价值。
这项多中心研究涉及八个心脏病学中心，连续纳入457例患者。测量血压、颈动脉内膜中层厚度（cIMT）、颈动脉脉搏波速度（cPWV）、心脏钙化的半定量评分、整体心肌纵向应变（GLS）以及左前降支（LAD）冠状动脉的静息多普勒流速。冠状动脉造影后，患者被分为CAD组（n = 273），即至少一处冠状动脉狭窄高于50%，以及无CAD组（n = 184）。
CAD组患者年龄更大（平均±标准差，65.9±10.7岁对63.1±11.2岁，P = 0.01），血压更高（137.0±18.8/77.5±11.1对130.2±17.4/75.1±9.7 mmHg，P < 0.02），cIMT更高（791.4±165.5对712.0±141.5 μm，P < 0.0001），cPWV更高（中位数：9对8.1 m/s，P < 0.01），钙化评分更高（中位数，2对1，P < 0.0001），LAD流速更高（中位数，38对36，P < 0.07），而GLS更低（-17.6±4.3对-19.3±5.1，P < 0.05）。钙化评分在所有患者中均可行，cIMT在97%的患者中可行，cPWV在86%的患者中可行，GLS在88%的患者中可行，LAD在84%的患者中可行。80%的患者可测量至少三个变量的组合。所有超声参数均能显著预测CAD。然而，在逐步逻辑回归中，阻塞性CAD的唯一联合预测指标是钙化评分、cIMT和LAD流速。
在意大利罗马的回声实验室，综合心血管超声研究在高比例患者中是可行的。钙评分、cIMT和LAD流速这三个参数的组合对阻塞性CAD具有递增的预测价值。
