Kim Hack-Lyoung, Kim Sang-Hyun
Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea.
Front Cardiovasc Med. 2019 Apr 9;6:41. doi: 10.3389/fcvm.2019.00041. eCollection 2019.
Early detection of subclinical atherosclerosis is important to reduce patients' cardiovascular risk. However, current diagnostic strategy focusing on traditional risk factors or using risk scoring is not satisfactory. Non-invasive imaging tools also have limitations such as cost, time, radiation hazard, renal toxicity, and requirement for specialized techniques or instruments. There is a close interaction between arterial stiffness and atherosclerosis. Increased luminal pressure and shear stress by arterial stiffening causes endothelial dysfunction, accelerates the formation of atheroma, and stimulates excessive collagen production and deposition in the arterial wall, leading to the progression of atherosclerosis. Pulse wave velocity (PWV), the most widely used measure of arterial stiffness, has emerged as a useful tool for the diagnosis and risk stratification of cardiovascular disease (CVD). The measurement of PWV is simple, non-invasive, and reproducible. There have been many clinical studies and meta-analyses showing the association between PWV and coronary/cerebral/carotid atherosclerosis. More importantly, longitudinal studies have shown that PWV is a significant risk factor for future CVD independent of well-known cardiovascular risk factors. The measurement of PWV may be a useful tool to select subjects at high risk of developing subclinical atherosclerosis or CVD especially in mass screening.
亚临床动脉粥样硬化的早期检测对于降低患者的心血管风险至关重要。然而,目前侧重于传统风险因素或使用风险评分的诊断策略并不令人满意。非侵入性成像工具也存在局限性,如成本、时间、辐射危害、肾毒性以及对专业技术或仪器的要求。动脉僵硬度与动脉粥样硬化之间存在密切的相互作用。动脉僵硬度导致的管腔内压力和剪切应力增加会引起内皮功能障碍,加速动脉粥样硬化斑块的形成,并刺激动脉壁中胶原蛋白的过度产生和沉积,从而导致动脉粥样硬化的进展。脉搏波速度(PWV)是最广泛使用的动脉僵硬度测量指标,已成为诊断心血管疾病(CVD)和进行风险分层的有用工具。PWV的测量简单、无创且可重复。已有许多临床研究和荟萃分析表明PWV与冠状动脉/脑/颈动脉粥样硬化之间存在关联。更重要的是,纵向研究表明,PWV是未来CVD的一个重要风险因素,独立于众所周知的心血管风险因素。PWV的测量可能是一种有用的工具,可用于选择有发展为亚临床动脉粥样硬化或CVD高风险的受试者,尤其是在大规模筛查中。