Jeremias Zsuzsanna, Rat Nora, Benedek Imre, Rapolti Emese, Ratiu Mihaela, Muresan Adrian, Benedek Theodora
1 Clinic of Cardiology, University of Medicine and Pharmacy, Tirgu Mures, Romania.
2 Department of Advanced Research in Multimodality Cardiovascular Imaging, Cardio Med Medical Center, Tirgu Mures, Romania.
Vasa. 2018 Aug;47(5):377-386. doi: 10.1024/0301-1526/a000718. Epub 2018 Jun 13.
The role of vascular calcifications in iliac arteries for predicting global atherosclerotic burden in still unknown. The aim of this study was to investigate whether iliac calcium score (ICS), a new computed tomographic angiography (CTA) derived biomarker of vascular calcification, can predict the severity and complexity of peripheral arterial disease (PAD) as well as the global atherosclerotic burden.
This was a single centre, non-randomized, observational prospective study on 84 consecutive patients with symptomatic peripheral arterial disease, undergoing peripheral CTA examination of the lower limbs, divided into high (n = 42) and low ICS (n = 42) groups with a median value for ICS of 3934 HU.
Patients with high ICS were significantly older (66.2 ± 8.0 vs. 62.8 ± 11.2, p < 0.0001) and were more frequently diabetic (61.9 vs. 38.1 %, p = 0.04). ICS was significantly higher in patients with Rutherford stage 5-6 vs. 1-2 (p = 0.03) and in TASC D or TASC C vs. TASC B class (p = 0.01). Mean iliac intima-media thickness (i-IMT) was significantly higher in the high ICS group compared to the low ICS group (1.3 ± 0.2 vs. 0.9 ± 0.2, p < 0.0001). Linear regression analysis demonstrated a very good correlation between ICS and i-IMT (r = 0.59, p < 0.0001 for right, r = 0.57, p < 0.0001 for left and r = 0.67, p < 0.0001 for both iliac arteries averaged). Patients with high ICS presented a significantly lower left ventricular ejection fraction compared to those with low ICS (45.3 ± 4.3 vs. 53.8 ± 4.8, p < 0.0001). Linear regression analysis demonstrated significant inverse correlation between ICS and left ventricular EF (r = -0.54, p < 0.0001).
Increased values of ICS, a new CTA marker of vascular calcification, are associated with a higher severity and complexity of PAD and a more depressed left ventricular function. High ICS values are also associated with increased i-IMT. Both can represent new surrogate markers of an increased atherosclerotic burden.
髂动脉血管钙化在预测整体动脉粥样硬化负担中的作用尚不清楚。本研究的目的是调查髂钙评分（ICS），一种新的基于计算机断层血管造影（CTA）得出的血管钙化生物标志物，是否能够预测外周动脉疾病（PAD）的严重程度和复杂性以及整体动脉粥样硬化负担。
这是一项单中心、非随机、观察性前瞻性研究，对84例有症状的外周动脉疾病连续患者进行下肢外周CTA检查，分为高ICS组（n = 42）和低ICS组（n = 42），ICS的中位数为3934 HU。
高ICS患者年龄显著更大（66.2±8.0岁 vs. 62.8±11.2岁，p < 0.0001），糖尿病患者更常见（61.9% vs. 38.1%，p = 0.04）。与卢瑟福分级1 - 2级相比，5 - 6级患者的ICS显著更高（p = 0.03）；与TASC B级相比，TASC D级或TASC C级患者的ICS显著更高（p = 0.01）。高ICS组的平均髂内膜中层厚度（i - IMT）显著高于低ICS组（1.3±0.2 vs. 0.9±0.2，p < 0.0001）。线性回归分析显示ICS与i - IMT之间具有良好的相关性（右侧r = 0.59，p < 0.0001；左侧r = 0.57，p < 0.0001；双侧髂动脉平均r = 0.67，p < 0.0001）。与低ICS患者相比，高ICS患者的左心室射血分数显著更低（45.3±4.3 vs. 53.8±4.8，p < 0.0001）。线性回归分析显示ICS与左心室射血分数之间存在显著负相关（r = -0.54，p < 0.0001）。
血管钙化新的CTA标志物ICS值升高与PAD的更高严重程度和复杂性以及更低下的左心室功能相关。高ICS值也与i - IMT增加相关。两者都可代表动脉粥样硬化负担增加的新替代标志物。
