Sun Jie, Zhao Xue-Qiao, Balu Niranjan, Neradilek Moni B, Isquith Daniel A, Yamada Kiyofumi, Cantón Gádor, Crouse John R, Anderson Todd J, Huston John, O'Brien Kevin, Hippe Daniel S, Polissar Nayak L, Yuan Chun, Hatsukami Thomas S
Department of Radiology, University of Washington, Seattle, Washington.
Department of Medicine, University of Washington, Seattle, Washington.
JACC Cardiovasc Imaging. 2017 Mar;10(3):241-249. doi: 10.1016/j.jcmg.2016.06.017.
The aim of this study was to investigate whether and what carotid plaque characteristics predict systemic cardiovascular outcomes in patients with clinically established atherosclerotic disease.
Advancements in atherosclerosis imaging have allowed assessment of various plaque characteristics, some of which are more directly linked to the pathogenesis of acute cardiovascular events compared to plaque burden.
As part of the event-driven clinical trial AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes), subjects with clinically established atherosclerotic disease underwent multicontrast carotid magnetic resonance imaging (MRI) to detect plaque tissue composition and high-risk features. Prospective associations between MRI measurements and the AIM-HIGH primary endpoint (fatal and nonfatal myocardial infarction, ischemic stroke, hospitalization for acute coronary syndrome, and symptom-driven revascularization) were analyzed using Cox proportional hazards survival models.
Of the 232 subjects recruited, 214 (92.2%) with diagnostic image quality constituted the study population (82% male, mean age 61 ± 9 years, 94% statin use). During median follow-up of 35.1 months, 18 subjects (8.4%) reached the AIM-HIGH endpoint. High lipid content (hazard ratio [HR] per 1 SD increase in percent lipid core volume: 1.57; p = 0.002) and thin/ruptured fibrous cap (HR: 4.31; p = 0.003) in carotid plaques were strongly associated with the AIM-HIGH endpoint. Intraplaque hemorrhage had a low prevalence (8%) and was marginally associated with the AIM-HIGH endpoint (HR: 3.00; p = 0.053). High calcification content (HR per 1 SD increase in percent calcification volume: 0.66; p = 0.20), plaque burden metrics, and clinical risk factors were not significantly associated with the AIM-HIGH endpoint. The associations between carotid plaque characteristics and the AIM-HIGH endpoint changed little after adjusting for clinical risk factors, plaque burden, or AIM-HIGH randomized treatment assignment.
Among patients with clinically established atherosclerotic disease, carotid plaque lipid content and fibrous cap status were strongly associated with systemic cardiovascular outcomes. Markers of carotid plaque vulnerability may serve as novel surrogate markers for systemic atherothrombotic risk.
本研究旨在调查在临床确诊的动脉粥样硬化疾病患者中，颈动脉斑块特征是否以及哪些特征能够预测全身心血管结局。
动脉粥样硬化成像技术的进步使得人们能够评估各种斑块特征，其中一些特征与急性心血管事件的发病机制的联系比斑块负荷更为直接。
作为事件驱动的临床试验AIM-HIGH（代谢综合征伴低高密度脂蛋白/高甘油三酯的动脉粥样硬化血栓形成干预：对全球健康结局的影响）的一部分，临床确诊动脉粥样硬化疾病的受试者接受了多对比颈动脉磁共振成像（MRI），以检测斑块组织成分和高危特征。使用Cox比例风险生存模型分析MRI测量值与AIM-HIGH主要终点（致命和非致命性心肌梗死、缺血性中风、急性冠状动脉综合征住院以及症状驱动的血运重建）之间的前瞻性关联。
在招募的232名受试者中，214名（92.2%）具有诊断图像质量的受试者构成了研究人群（82%为男性，平均年龄61±9岁，94%使用他汀类药物）。在35.1个月的中位随访期间，18名受试者（8.4%）达到了AIM-HIGH终点。颈动脉斑块中高脂质含量（脂质核心体积百分比每增加1个标准差的风险比[HR]：1.57；p = 0.002）和薄/破裂纤维帽（HR：4.31；p = 0.003）与AIM-HIGH终点密切相关。斑块内出血的患病率较低（8%），与AIM-HIGH终点有边缘关联（HR：3.00；p = 0.053）。高钙化含量（钙化体积百分比每增加1个标准差的HR：0.66；p = 0.20）、斑块负荷指标和临床风险因素与AIM-HIGH终点无显著关联。在调整临床风险因素、斑块负荷或AIM-HIGH随机治疗分配后，颈动脉斑块特征与AIM-HIGH终点之间的关联变化不大。
在临床确诊的动脉粥样硬化疾病患者中，颈动脉斑块脂质含量和纤维帽状态与全身心血管结局密切相关。颈动脉斑块易损性标志物可能作为全身动脉粥样硬化血栓形成风险的新型替代标志物。
