Santos-Neto P J, Sena-Santos E H, Meireles D P, Santos I S, Bensenor I M, Lotufo P A
Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil.
Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Braz J Med Biol Res. 2019;52(8):e8711. doi: 10.1590/1414-431X20198711. Epub 2019 Aug 5.
Carotid artery assessment by ultrasound is a non-invasive evaluation of subclinical atherosclerosis and a predictor of cardiovascular events. However, ultrasound examinations are operator-dependent. In the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), ultrasound images have been acquired from more than 10,000 participants. In this article, we describe the reproducibility of carotid intima-media thickness (CIMT), carotid plaque detection, and carotid plaque score (defined as the number of arterial sites with plaques) using ELSA-Brasil protocol, in a subset of 118 participants. Two board-certified radiologists and a trained technician read carotid images. We calculated intra- and inter-observer intraclass correlation (ICC) for CIMT values. We also present kappa coefficients for plaque detection and weighted kappa coefficients for carotid plaque score. Participants were aged 58.2±6.6 years, and 60 (50.8%) were men. For common carotid artery CIMT measurements, intra- and inter-observer ICC values were very good to excellent, ranging from 0.90 (95% confidence interval [95%CI]: 0.72-0.95) to 0.98 (95%CI: 0.97-0.99). For carotid plaque, intra- (0.96 [95%CI: 0.96-0.96]) and inter- (0.99 [95%CI: 0.99-0.99]) observer weighted kappa coefficients were very good. Intra- and inter-observer Kappa coefficients for the presence of plaques by site were good to very good, ranging from 0.69 to 1.00. In conclusion, we found very good reproducibility for carotid plaque score and CIMT measurements in the ELSA-Brasil at baseline. These results are comparable to the best findings from similar large cohorts that analyzed carotid ultrasound data.
通过超声评估颈动脉是对亚临床动脉粥样硬化的一种非侵入性评估，也是心血管事件的一个预测指标。然而，超声检查依赖于操作人员。在巴西成人健康纵向研究（ELSA - Brasil）中，已从超过10000名参与者身上获取了超声图像。在本文中，我们描述了在118名参与者的子集中，使用ELSA - Brasil方案对颈动脉内膜中层厚度（CIMT）、颈动脉斑块检测和颈动脉斑块评分（定义为有斑块的动脉部位数量）的可重复性。两名具有董事会认证的放射科医生和一名经过培训的技术人员解读颈动脉图像。我们计算了CIMT值的观察者内和观察者间组内相关系数（ICC）。我们还给出了斑块检测的kappa系数和颈动脉斑块评分的加权kappa系数。参与者年龄为58.2±6.6岁，其中60名（50.8%）为男性。对于颈总动脉CIMT测量，观察者内和观察者间ICC值非常好至极好，范围从0.90（95%置信区间[95%CI]：0.72 - 0.95）到0.98（95%CI：0.97 - 0.99）。对于颈动脉斑块，观察者内（0.96 [95%CI：0.96 - 0.96]）和观察者间（0.99 [95%CI：0.99 - 0.99]）加权kappa系数非常好。按部位划分的斑块存在情况的观察者内和观察者间kappa系数良好至非常好，范围从0.69到1.00。总之，我们发现在ELSA - Brasil研究基线时，颈动脉斑块评分和CIMT测量具有非常好的可重复性。这些结果与分析颈动脉超声数据的类似大型队列的最佳发现相当。
