应用剪切波弹性成像技术测量颈动脉弹性模量对无颈动脉斑块的冠心病患者的诊断价值。
Incremental value of carotid elasticity modulus using shear wave elastography for identifying coronary artery disease in patients without carotid plaque.
机构信息
Department of Cardiovascular Ultrasound.
Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
出版信息
J Hypertens. 2021 Jun 1;39(6):1210-1220. doi: 10.1097/HJH.0000000000002773.
BACKGROUND
Shear wave elastography (SWE) directly quantifies the local arterial wall stiffness by calculating the elastic modulus. However, whether carotid wall elastic modulus can predict obstructive coronary artery disease (CAD) is not well known. We aimed to investigate the value of carotid wall elastic modulus measured using SWE in identifying obstructive CAD.
MATERIALS AND METHODS
We prospectively enrolled 61 patients without carotid plaque referred for clinically indicated coronary angiography. Twenty-seven (44.3%) patients were diagnosed with obstructive CAD (≥50% coronary stenosis). The elastic modulus of common carotid artery was quantified using SWE. Ankle--brachial index (ABI) and echocardiographic global cardiac calcium score (GCCS) were measured.
RESULTS
Patients with obstructive CAD had significantly higher elastic modulus than those without obstructive CAD. The maximum elastic modulus (EMmax) was independently associated with obstructive CAD after adjusting for the Framingham risk score, ABI, and GCCS. EMmax had the highest area under the curve (AUC) to identify obstructive CAD (AUC 0.70; P = 0.003). In the nested models, the model based on the Framingham risk score and ABI (χ2 = 3.74) improved by adding GCCS (χ2 = 9.95) and further improved by adding EMmax (χ2 = 15.86). Adding EMmax to the combined ABI and GCCS model increased integrated discrimination index from 0.10 to 0.19.
CONCLUSION
Carotid wall elastic modulus measured using SWE is a useful predictor of obstructive CAD in patients without carotid plaque. We demonstrated the incremental and independent value of carotid wall elastic modulus in identifying obstructive CAD compared with clinical risk factors and other imaging predictors, including ABI and GCCS.
VIDEO ABSTRACT
Please see the video, in Supplemental Digital Content 1, http://links.lww.com/HJH/B551 for more insights from the authors.
背景
剪切波弹性成像（SWE）通过计算弹性模量直接量化局部动脉壁硬度。然而，颈动脉壁弹性模量是否可以预测阻塞性冠状动脉疾病（CAD）尚不清楚。我们旨在研究使用 SWE 测量的颈动脉壁弹性模量在识别阻塞性 CAD 中的价值。
材料和方法
我们前瞻性纳入了 61 例因临床指征而行冠状动脉造影检查且无颈动脉斑块的患者。27 例（44.3%）患者被诊断为阻塞性 CAD（≥50%冠状动脉狭窄）。使用 SWE 量化颈总动脉弹性模量。测量踝臂指数（ABI）和超声心动图全心脏钙评分（GCCS）。
结果
患有阻塞性 CAD 的患者的弹性模量明显高于无阻塞性 CAD 的患者。最大弹性模量（EMmax）在调整Framingham 风险评分、ABI 和 GCCS 后与阻塞性 CAD 独立相关。EMmax 识别阻塞性 CAD 的曲线下面积（AUC）最高（AUC 0.70；P=0.003）。在嵌套模型中，基于Framingham 风险评分和 ABI 的模型（χ2=3.74）通过加入 GCCS（χ2=9.95）得到改善，通过加入 EMmax 进一步得到改善（χ2=15.86）。将 EMmax 加入ABI 和 GCCS 的联合模型中，使综合判别指数从 0.10 增加到 0.19。
结论
使用 SWE 测量的颈动脉壁弹性模量是无颈动脉斑块患者阻塞性 CAD 的有用预测指标。与临床危险因素和其他成像预测因素（包括 ABI 和 GCCS）相比，我们证明了颈动脉壁弹性模量在识别阻塞性 CAD 方面具有增量和独立的价值。
视频摘要
请在补充数字内容 1 的视频中查看，网址为：http://links.lww.com/HJH/B551，以获取作者的更多见解。
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