Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
Diagnostic and Interventional Radiology, Prince of Wales Hospital, Hong Kong.
RMD Open. 2020 Sep;6(3). doi: 10.1136/rmdopen-2020-001364.
This study aimed to assess the performance of carotid ultrasound (US) parameters alone or in combination with Framingham Risk Score (FRS) in discriminating patients with psoriatic arthritis (PsA) with and without coronary artery disease (CAD).
Ninety-one patients with PsA (56 males; age: 50±11 years, disease duration: 9.4±9.2 years) without overt cardiovascular (CV) diseases were recruited. Carotid intima-media thickness (cIMT), the presence of plaque and total plaque area (TPA) was determined by high-resolution US. CAD was defined as the presence of any coronary plaque on coronary CT angiography (CCTA). Obstructive-CAD (O-CAD) was defined as >50% stenosis of the lumen.
Thirty-five (38%) patients had carotid plaque. Fifty-four (59%) patients had CAD (CAD+) and 9 (10%) patients had O-CAD (O-CAD+). No significant associations between the presence of carotid plaque and CAD were found. However, cIMT and TPA were higher in both the CAD+ and O-CAD+ group compared with the CAD- or O-CAD- groups, respectively. Multivariate logistic regression analysis revealed that mean cIMT was an independent explanatory variable associated with CAD and O-CAD, while maximum cIMT and TPA were independent explanatory variables associated with O-CAD after adjusting for covariates. The optimal cut-offs for detecting the presence of CAD were FRS >5% and mean cIMT at 0.62 mm (AUC: 0.71; sensitivity: 67%; specificity: 76%), while the optimal cut-offs for detecting the presence of O-CAD were FRS >10% in combination with mean cIMT at 0.73 mm (AUC: 0.71; sensitivity: 56%; specificity: 85%).
US parameters including cIMT and TPA may be considered in addition to FRS for CV risk stratification in patients with PsA.
本研究旨在评估颈动脉超声（US）参数单独或与弗莱明汉风险评分（FRS）联合用于鉴别伴有或不伴有冠状动脉疾病（CAD）的银屑病关节炎（PsA）患者的性能。
共招募了 91 例无明显心血管（CV）疾病的 PsA 患者（56 名男性；年龄：50±11 岁，病程：9.4±9.2 年）。通过高分辨率 US 确定颈动脉内膜中层厚度（cIMT）、斑块存在情况和总斑块面积（TPA）。CAD 定义为冠状动脉 CT 血管造影（CCTA）上任何冠状动脉斑块的存在。阻塞性 CAD（O-CAD）定义为管腔狭窄>50%。
35 例（38%）患者存在颈动脉斑块。54 例（59%）患者有 CAD（CAD+），9 例（10%）患者有 O-CAD（O-CAD+）。颈动脉斑块的存在与 CAD 之间无显著相关性。然而，与 CAD-或 O-CAD-组相比，CAD+和 O-CAD+组的 cIMT 和 TPA 均较高。多变量逻辑回归分析显示，平均 cIMT 是与 CAD 和 O-CAD 相关的独立解释变量，而最大 cIMT 和 TPA 是调整协变量后与 O-CAD 相关的独立解释变量。检测 CAD 存在的最佳截断值为 FRS>5%和平均 cIMT 为 0.62mm（AUC：0.71；灵敏度：67%；特异性：76%），检测 O-CAD 存在的最佳截断值为 FRS>10%联合平均 cIMT 为 0.73mm（AUC：0.71；灵敏度：56%；特异性：85%）。
在 PsA 患者中，除了 FRS 外，还可以考虑 US 参数（包括 cIMT 和 TPA）进行 CV 风险分层。
