Strecker Christoph, Krafft Axel Joachim, Kaufhold Lilli, Hüllebrandt Markus, Treppner Martin, Ludwig Ute, Köber Göran, Hennemuth Anja, Hennig Jürgen, Harloff Andreas
Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.
Department of Radiology-Medical Physics, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.
Front Cardiovasc Med. 2021 Oct 26;8:723860. doi: 10.3389/fcvm.2021.723860. eCollection 2021.
Carotid geometry and wall shear stress (WSS) have been proposed as independent risk factors for the progression of carotid atherosclerosis, but this has not yet been demonstrated in larger longitudinal studies. Therefore, we investigated the impact of these biomarkers on carotid wall thickness in patients with high cardiovascular risk. Ninety-seven consecutive patients with hypertension, at least one additional cardiovascular risk factor and internal carotid artery (ICA) plaques (wall thickness ≥ 1.5 mm and degree of stenosis ≤ 50%) were prospectively included. They underwent high-resolution 3D multi-contrast and 4D flow MRI at 3 Tesla both at baseline and follow-up. Geometry (ICA/common carotid artery (CCA)-diameter ratio, bifurcation angle, tortuosity and wall thickness) and hemodynamics [WSS, oscillatory shear index (OSI)] of both carotid bifurcations were measured at baseline. Their predictive value for changes of wall thickness 12 months later was calculated using linear regression analysis for the entire study cohort (group 1, 97 patients) and after excluding patients with ICA stenosis ≥10% to rule out relevant inward remodeling (group 2, 61 patients). In group 1, only tortuosity at baseline was independently associated with carotid wall thickness at follow-up (regression coefficient = -0.52, < 0.001). However, after excluding patients with ICA stenosis ≥10% in group 2, both ICA/CCA-ratio (0.49, < 0.001), bifurcation angle (0.04, = 0.001), tortuosity (-0.30, = 0.040), and WSS (-0.03, = 0.010) at baseline were independently associated with changes of carotid wall thickness at follow-up. A large ICA bulb and bifurcation angle and low WSS seem to be independent risk factors for the progression of carotid atherosclerosis in the absence of ICA stenosis. By contrast, a high carotid tortuosity seems to be protective both in patients without and with ICA stenosis. These biomarkers may be helpful for the identification of patients who are at particular risk of wall thickness progression and who may benefit from intensified monitoring and treatment.
颈动脉几何形态和壁面切应力（WSS）已被提出是颈动脉粥样硬化进展的独立危险因素，但在更大规模的纵向研究中尚未得到证实。因此，我们研究了这些生物标志物对心血管疾病高危患者颈动脉壁厚度的影响。前瞻性纳入了97例连续的高血压患者，这些患者至少还有一种其他心血管危险因素且存在颈内动脉（ICA）斑块（壁厚度≥1.5 mm且狭窄程度≤50%）。他们在基线和随访时均接受了3特斯拉的高分辨率3D多对比和4D流动磁共振成像检查。在基线时测量了双侧颈动脉分叉处的几何形态（ICA/颈总动脉（CCA）直径比、分叉角度、迂曲度和壁厚度）和血流动力学参数[WSS、振荡剪切指数（OSI）]。使用线性回归分析计算了它们对12个月后壁厚度变化的预测价值，分析对象为整个研究队列（第1组，97例患者）以及排除了ICA狭窄≥10%的患者以排除相关内向重塑后的队列（第2组，61例患者）。在第1组中，仅基线时的迂曲度与随访时的颈动脉壁厚度独立相关（回归系数 = -0.52，<0.001）。然而，在第2组中排除了ICA狭窄≥10%的患者后，基线时的ICA/CCA比（0.49，<0.001）、分叉角度（0.04，=0.001）、迂曲度（-0.30，=0.040）和WSS（-0.03，=0.010）均与随访时的颈动脉壁厚度变化独立相关。在无ICA狭窄的情况下，较大的ICA球部和分叉角度以及较低的WSS似乎是颈动脉粥样硬化进展的独立危险因素。相比之下，较高的颈动脉迂曲度似乎对无ICA狭窄和有ICA狭窄的患者均具有保护作用。这些生物标志物可能有助于识别那些颈动脉壁厚度进展风险特别高且可能从强化监测和治疗中获益的患者。
