Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark.
Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Eur Heart J Cardiovasc Imaging. 2018 Sep 1;19(9):1042-1050. doi: 10.1093/ehjci/jex239.
Prediction of cardiovascular events improves using imaging, i.e. coronary calcium score and ultrasound assessment of carotid plaque. This study analysed the predictive value of two ultrasound measures of carotid plaque size: carotid plaque thickness and carotid and intima-media thickness (IMT).
A total of 6102 asymptomatic persons underwent assessment of conventional risk factors and imaging by carotid ultrasound. Carotid plaque burden (cPB) and maximum carotid plaque thickness (cPTmax) were measured from 'cross-sectional sweep' video acquisition of the carotid artery. IMT was measured from distal common carotid artery images. All participants were followed up for ∼3 years, and major cardiovascular events (MACE) were collected and adjudicated. All data were available for 5808 participants, in whom 216 first MACE events were observed. Increasing both cPB and cPTmax were associated with increasing the risk of future MACE when compared with participants without carotid atherosclerosis. Fully adjusted for risk factors, hazard ratios for cPTmax were 1.96 [95% confidence interval (CI) 0.91-4.25, P = 0.015] for primary MACE and 3.13 (95% CI 1.80-5.51, P < 0.001) for secondary MACE, similar to that of cPB. IMT did not improve risk prediction significantly. Non-categorical net reclassification index (NRI) for cPTmax was 0.178 (95% CI 0.027-0.299, P = 0.032) for primary MACE and 0.173 (95% CI 0.109-0.243, P < 0.001) for secondary MACE, which is almost similar to cPB. IMT assessment did not result in significant NRI.
The simpler cPTmax predicted cardiovascular events similarly to the more comprehensive cPB, whereas IMT did not. Awaiting true 3D ultrasound technology cPTmax may be a simple useful measure for prediction of future ASCVD.
通过影像学（即冠状动脉钙评分和颈动脉斑块超声评估）可提高心血管事件的预测能力。本研究分析了两种颈动脉斑块大小的超声测量指标（颈动脉斑块厚度和颈动脉内膜中层厚度（IMT））的预测价值。
共有 6102 名无症状者接受了常规风险因素评估和颈动脉超声检查。从颈动脉的“横断面扫描”视频采集测量颈动脉斑块负荷（cPB）和最大颈动脉斑块厚度（cPTmax）。从颈总动脉远端图像测量 IMT。所有参与者随访了约 3 年，收集并裁决了主要心血管事件（MACE）。所有数据均可供 5808 名参与者使用，其中 216 名参与者首次发生 MACE。与无颈动脉粥样硬化的参与者相比，cPB 和 cPTmax 增加均与未来发生 MACE 的风险增加相关。完全调整危险因素后，cPTmax 的主要 MACE 风险比为 1.96（95%置信区间（CI）0.91-4.25，P=0.015），次要 MACE 为 3.13（95%CI 1.80-5.51，P<0.001），与 cPB 相似。IMT 对风险预测无显著改善。cPTmax 的非分类净重新分类指数（NRI）对于主要 MACE 为 0.178（95%CI 0.027-0.299，P=0.032），对于次要 MACE 为 0.173（95%CI 0.109-0.243，P<0.001），与 cPB 几乎相同。IMT 评估未导致 NRI 显著增加。
更简单的 cPTmax 与更全面的 cPB 同样可预测心血管事件，而 IMT 则不然。在等待真正的 3D 超声技术时，cPTmax 可能是预测未来 ASCVD 的一种简单有用的测量方法。
