Kim Gee-Hee, Youn Ho-Joong
Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, Suwon, Korea.
Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Korean Circ J. 2017 Jan;47(1):1-8. doi: 10.4070/kcj.2016.0232. Epub 2016 Nov 24.
Carotid ultrasound is an imaging modality that allows non-invasive assessment of vascular anatomy and function. Carotid intima-media thickness (IMT) has been shown to predict cardiovascular (CV) risk in multiple large studies. However, in 2013, American College of Cardiology/American Heart Association guidelines designated that the carotid IMT as class III evidence level was not recommended for use in clinical practice as a routine measurement of risk assessment for a first atherosclerotic CV event. Following the announcement of this guideline, combined common carotid IMT and plaque, including plaque tissue characterization and plaque burden, using 3D ultrasound was reported to be better than either measurement alone in a variety of studies. Moreover, changes in the intima thickness were related to aging and early atherosclerosis, and remodeling of the media thickness was associated with hypertension. Separate measurement is useful for evaluating the effects of different atherosclerotic risk factors on the arterial wall; however, a more detailed and elaborate technique needs to be developed. If so, separate measurement will play an important role in the assessment of atherosclerosis and arterial wall change according to a variety of risk factors, such as metabolic syndrome. In addition, although carotid blood flow velocity is a useful tool for risk classification and prediction in clinical practice, further clinical research is needed. The value of carotid IMT by ultrasound examination for risk stratification remains controversial, and groups developing future guidelines should consider the roles of plaque presence and burden and hemodynamic parameters in additional risk stratification beyond carotid IMT in clinical practice.
颈动脉超声是一种能够对血管解剖结构和功能进行无创评估的成像方式。在多项大型研究中，颈动脉内膜中层厚度（IMT）已被证明可预测心血管（CV）风险。然而，2013年美国心脏病学会/美国心脏协会指南指出，不建议将颈动脉IMT作为III类证据水平用于临床实践中作为首次动脉粥样硬化性CV事件风险评估的常规测量方法。在该指南发布后，多项研究报道，使用三维超声测量颈总动脉IMT与斑块（包括斑块组织特征和斑块负荷）相结合，比单独测量任何一项都更具优势。此外，内膜厚度的变化与衰老和早期动脉粥样硬化有关，而中膜厚度的重塑与高血压有关。单独测量对于评估不同动脉粥样硬化危险因素对动脉壁的影响很有用；然而，需要开发更详细、更精细的技术。如果是这样，单独测量将在根据代谢综合征等多种危险因素评估动脉粥样硬化和动脉壁变化方面发挥重要作用。此外，虽然颈动脉血流速度在临床实践中是进行风险分类和预测的有用工具，但仍需要进一步的临床研究。超声检查测量颈动脉IMT用于风险分层的价值仍存在争议，制定未来指南的小组应在临床实践中考虑斑块的存在、负荷以及血流动力学参数在颈动脉IMT之外的额外风险分层中的作用。
