Timóteo Ana Teresa, Mota Carmo Miguel, Soares Cristina, Ferreira Rui Cruz
Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
Centro de Estudos de Doenças Crónicas (CEDOC), NOVA Medical School, Lisbon, Portugal.
Echocardiography. 2019 Jan;36(1):125-132. doi: 10.1111/echo.14207. Epub 2018 Nov 26.
Carotid intima-media thickness (CIMT) is an established surrogate marker for cardiovascular events in patients with intermediate risk. In patients with high cardiovascular risk or established cardiovascular disease, the impact of CMIT measurement on risk stratification for future events is less clear. Our objective was to evaluate the impact of CIMT on the occurrence of cardiovascular events in a cohort of individuals with high cardiovascular risk, in long-term follow-up.
We analyzed 296 individuals, mean follow-up of 6.9 ± 2.2 years. Individuals were divided into tertiles according to CIMT. Tertiles were compared in terms of baseline characteristics and outcomes during follow-up-all-cause mortality and composite outcome (mortality, acute coronary syndromes, coronary revascularization, stroke/transient ischemic attack, heart failure, or cardiovascular admission).
Our population had a mean age of 65 ± 9 years at the beginning of the study, 55% males. Patients with higher CIMT showed a trend for higher cardiovascular mortality (P = 0.084) and for the composite outcome (P = 0.049). A CIMT ≥ 0.85 mm was also associated with higher rate of events; however, CIMT was not an independent predictor of outcome after adjustment for age and gender. CIMT assessment was useful in patients with hypertension, hyperlipidemia, and metabolic syndrome and in nondiabetic patients. For the composite outcome, it was also useful in females, smokers, and in patients without coronary artery disease.
Patients with higher CIMT have worst outcome, but this was mainly driven by age and gender. CIMT is useful as a prognostic marker in specific subsets of patients.
颈动脉内膜中层厚度（CIMT）是中度风险患者心血管事件的既定替代标志物。在心血管高风险或已确诊心血管疾病的患者中，CMIT测量对未来事件风险分层的影响尚不清楚。我们的目标是在长期随访中评估CIMT对一组心血管高风险个体心血管事件发生情况的影响。
我们分析了296名个体，平均随访6.9±2.2年。根据CIMT将个体分为三分位数。比较三分位数在基线特征和随访期间的结局——全因死亡率和复合结局（死亡率、急性冠状动脉综合征、冠状动脉血运重建、中风/短暂性脑缺血发作、心力衰竭或心血管住院）。
我们的研究人群在研究开始时的平均年龄为65±9岁，男性占55%。CIMT较高的患者心血管死亡率（P = 0.084）和复合结局（P = 0.049）呈上升趋势。CIMT≥0.85 mm也与较高的事件发生率相关；然而，在调整年龄和性别后，CIMT不是结局的独立预测因素。CIMT评估对高血压、高脂血症和代谢综合征患者以及非糖尿病患者有用。对于复合结局，它对女性、吸烟者和无冠状动脉疾病的患者也有用。
CIMT较高的患者结局较差，但这主要由年龄和性别驱动。CIMT在特定患者亚组中作为预后标志物有用。
