Department of Cardiovascular Medicine and Institute for Medical Research, Northwick Park Hospital, Harrow, United Kingdom; Cardiovascular Biomedical Research Unit, Imperial College, London and Royal Brompton Hospital, London, United Kingdom.
Department of Cardiovascular Medicine and Institute for Medical Research, Northwick Park Hospital, Harrow, United Kingdom.
JACC Cardiovasc Imaging. 2018 Feb;11(2 Pt 1):173-180. doi: 10.1016/j.jcmg.2016.12.020. Epub 2017 Apr 12.
This study hypothesized that ischemia and atherosclerosis assessment by ultrasound (US) may provide incremental prognostic information in patients with new-onset chest pain who do not have coronary artery disease (CAD).
The clinical significance of atherosclerosis assessment by carotid US in patients undergoing stress echocardiography (SE) in such patients is unknown.
Consecutive patients with suspected angina but no history of CAD underwent simultaneous SE and US prospectively to assess myocardial ischemia and carotid plaque burden (CPB), respectively. Patients were followed up for major adverse events (MAEs)-all-cause mortality, nonfatal myocardial infarction, and unplanned coronary revascularization.
Of 591 recruited patients, 580 (men, 46%; mean age 59 ± 11 years) patients were available for follow-up. SE demonstrated myocardial ischemia in 12%, but prevalence of carotid plaques was 59%. During a mean follow-up of 1,117 ± 361 days, 40 first MAEs occurred. In the multivariable regression model, pre-test probability (PTP) of CAD (p = 0.001), abnormal SE (p < 0.0001), and CPB (p < 0.0001) predicted MAEs. MAE rates per year increased from 0.9% versus 1.97% versus 4.3% versus 9.7% in patients with no carotid plaque and normal SE versus patients who had plaque and normal SE versus those with no plaque and abnormal SE versus patients with plaque and abnormal SE, respectively (p < 0.0001). In hierarchical analysis, plaque burden provided incremental prognostic value over PTP of CAD and SE; likewise, SE was incremental to PTP-CAD and CPB (p < 0.0001 for both).
In patients with suspected stable angina without known CAD, simultaneous SE (for ischemia) and US (for atherosclerosis) provided incremental prognostic value.
本研究假设，对于新发胸痛且无冠心病（CAD）的患者，通过超声（US）评估缺血和动脉粥样硬化情况可能提供额外的预后信息。
在这些患者中，行应激超声心动图（SE）检查的患者，颈动脉 US 评估动脉粥样硬化的临床意义尚不清楚。
连续纳入疑似心绞痛但无 CAD 病史的患者，前瞻性地同时行 SE 和 US 检查，分别评估心肌缺血和颈动脉斑块负担（CPB）。患者进行了主要不良事件（MAEs）的随访，包括全因死亡率、非致死性心肌梗死和计划外冠状动脉血运重建。
在纳入的 591 例患者中，580 例（男性占 46%；平均年龄 59±11 岁）患者可进行随访。SE 显示 12%的患者存在心肌缺血，但颈动脉斑块的发生率为 59%。在平均 1117±361 天的随访期间，发生了 40 例首次 MAEs。在多变量回归模型中，CAD 的预测试概率（PTP）（p=0.001）、异常 SE（p<0.0001）和 CPB（p<0.0001）预测 MAEs。无颈动脉斑块且 SE 正常的患者 MAE 发生率为每年 0.9%，而斑块和 SE 正常、无斑块和异常 SE、有斑块和异常 SE 的患者分别为每年 1.97%、4.3%和 9.7%（p<0.0001）。在分层分析中，斑块负担比 CAD 的 PTP 和 SE 提供了更多的预后价值；同样，SE 比 CAD 的 PTP 和 CPB 更具增量预后价值（两者均 p<0.0001）。
在疑似稳定型心绞痛且无已知 CAD 的患者中，同时进行 SE（评估缺血）和 US（评估动脉粥样硬化）可提供额外的预后价值。
