Division of Cardiology, Mount Sinai St. Luke's Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, New York.
Intermountain Medical Center Heart Institute, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah.
JACC Cardiovasc Imaging. 2017 Mar;10(3):304-317. doi: 10.1016/j.jcmg.2017.01.009.
The optimal approach for screening for cardiovascular disease remains controversial. A new standard of "therapeutic efficacy" requires that screening tests which involve cardiac imaging not only predict events but also improve clinical outcomes compared with usual care. To date, 5 prospective randomized trials have been conducted to compare outcomes based on imaging-guided screening and prevention versus assignment to usual care in screening populations. One trial involved cardiac stress imaging, 3 involved coronary artery calcium scanning, and 1 involved coronary computed tomography angiography. Due to the current very low event risk in asymptomatic populations, these trials have been substantially underpowered to assess the impact of imaging-guided prevention on hard cardiac events. This review derives lessons learned from these trials relative to the future design of imaging-based screening trials, including analysis regarding the optimal methods for screening, and what are the relevant clinical outcomes to assess the efficacy of imaging-based screening for prevention.
心血管疾病筛查的最佳方法仍存在争议。新的“治疗效果”标准要求，涉及心脏成像的筛查试验不仅要预测事件，而且要与常规护理相比改善临床结局。迄今为止，已经进行了 5 项前瞻性随机试验，以比较基于影像学筛查和预防与常规护理在筛查人群中的结果。一项试验涉及心脏应激成像，3 项涉及冠状动脉钙扫描，1 项涉及冠状动脉计算机断层扫描血管造影。由于目前无症状人群的事件风险非常低，这些试验在评估影像学指导预防对心脏硬终点的影响方面的效力严重不足。本综述从这些试验中汲取了未来基于影像学的筛查试验设计的经验教训，包括关于最佳筛查方法的分析，以及评估影像学筛查预防效果的相关临床结局。
