无症状中年运动员冠心病的识别：脉搏波速度的附加价值
Identifying Coronary Artery Disease in Asymptomatic Middle-Aged Sportsmen: The Additional Value of Pulse Wave Velocity.
作者信息
Braber Thijs L, Prakken Niek H J, Mosterd Arend, Mali Willem P Th M, Doevendans Pieter A F M, Bots Michiel L, Velthuis Birgitta K
机构信息
Department of Radiology, University Medical Center Utrecht, The Netherlands; Department of Cardiology, University Medical Center Utrecht, The Netherlands.
Department of Radiology, University Medical Center Groningen, The Netherlands.
出版信息
PLoS One. 2015 Jul 6;10(7):e0131895. doi: 10.1371/journal.pone.0131895. eCollection 2015.
BACKGROUND
Cardiovascular screening may benefit middle-aged sportsmen, as coronary artery disease (CAD) is the main cause of exercise-related sudden cardiac death. Arterial stiffness, as measured by pulse wave velocity (PWV), may help identify sportsmen with subclinical CAD. We examined the additional value of PWV measurements to traditional CAD risk factors for identifying CAD.
METHODS
From the Measuring Athlete's Risk of Cardiovascular events (MARC) cohort of asymptomatic, middle-aged sportsmen who underwent low-dose Cardiac CT (CCT) after routine sports medical examination (SME), 193 consecutive sportsmen (aged 55 ± 6.6 years) were included with additional PWV measurements before CCT. Sensitivity, specificity and predictive values of PWV values (>8.3 and >7.5 m/s) assessed by Arteriograph were used to identify CAD (coronary artery calcium scoring ≥ 100 Agatston Units or coronary CT angiography luminal stenosis ≥ 50%) and to assess the additional diagnostic value of PWV to established cardiovascular risk factors.
RESULTS
Forty-seven sportsmen (24%) had CAD on CCT. They were older (58.9 vs. 53.8 years, p<0.001), had more hypertension (17 vs. 4%, p=0.003), higher cholesterol levels (5.7 vs. 5.4 mmol/l) p=0.048), and more often were (ever) smokers (55 vs. 34%, p=0.008). Mean PWV was higher in those with CAD (8.9 vs. 8.0 m/s, p=0.017). For PWV >8.3m/s respectively >7.5 m/s sensitivity to detect CAD on CT was 43% and 74%, specificity 69% and 45%, positive predictive value 31% and 30%, and negative predictive value 79% and 84%. Adding PWV to traditional risk factor models did not change the area under the curve (from 0.78 (95% CI = 0.709-0.848)) to AUC 0.78 (95% CI 0.710-0.848, p = 0.99)) for prediction of CAD on CCT.
CONCLUSIONS
Limited additional value was found for PWV on top of established risk factors to identify CAD. PWV might still have a role to identify CAD in middle-aged sportsmen if risk factors such as cholesterol are unknown.
背景
心血管筛查可能使中年运动员受益，因为冠状动脉疾病（CAD）是运动相关心脏性猝死的主要原因。通过脉搏波速度（PWV）测量的动脉僵硬度可能有助于识别患有亚临床CAD的运动员。我们研究了PWV测量对于传统CAD危险因素在识别CAD方面的附加价值。
方法
从测量运动员心血管事件风险（MARC）队列中选取无症状的中年运动员，他们在常规运动医学检查（SME）后接受了低剂量心脏CT（CCT）检查，连续纳入193名运动员（年龄55±6.6岁），在CCT检查前进行了额外的PWV测量。通过动脉造影仪评估的PWV值（>8.3和>7.5 m/s）的敏感性、特异性和预测值用于识别CAD（冠状动脉钙化评分≥100阿加斯顿单位或冠状动脉CT血管造影管腔狭窄≥50%），并评估PWV对已确定的心血管危险因素的附加诊断价值。
结果
47名运动员（24%）在CCT检查中患有CAD。他们年龄更大（58.9岁对vs . 53.8岁，p<0.001），高血压患者更多（17%对4%，p=0.003），胆固醇水平更高（5.7对5.4 mmol/l，p=0.048），且吸烟者更常见（55%对34%，p=0.008）。CAD患者的平均PWV更高（8.9对8.0 m/s，p=0.017）。对于PWV>8.3m/s和>7.5 m/s，CT检测CAD的敏感性分别为43%和74%，特异性为69%和45%，阳性预测值为31%和30%，阴性预测值为79%和84%。将PWV添加到传统危险因素模型中，对于CCT上CAD的预测，曲线下面积没有变化（从0.78（95%CI = 0.709 - 0.848）变为AUC 0.78（95%CI 0.710 - 0.848，p = 0.99））。
结论
在已确定的危险因素基础上，发现PWV在识别CAD方面的附加价值有限。如果胆固醇等危险因素未知，PWV可能在识别中年运动员的CAD方面仍有作用。
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