Emory Center for Heart Disease Prevention.
Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia.
Curr Opin Cardiol. 2023 Nov 1;38(6):509-514. doi: 10.1097/HCO.0000000000001081. Epub 2023 Aug 24.
To provide a summary of the current evidence and highlight future directions regarding coronary artery calcium (CAC) and risk of sudden cardiac death (SCD).
Although up to 80% of all SCD is attributed to coronary heart disease (CHD), the subclinical atherosclerosis markers that help to improve SCD risk prediction are largely unknown. Recent observational data have demonstrated that, after adjustment for traditional risk factors, there is a stepwise higher risk for SCD across increasing CAC burden such that asymptomatic patients without overt atherosclerotic cardiovascular disease (ASCVD) experience a three-fold to five-fold higher SCD risk beginning at CAC at least 100 when compared with CAC = 0. Although the mechanisms underlying increasing CAC and SCD risk have yet to be fully elucidated, risk for myocardial infarction and scar, and/or exercise-induced ischemia may be potential mediators.
High CAC burden is an important risk factor for SCD in asymptomatic middle-aged adults, suggesting that SCD risk stratification can begin in the early stages of CHD via measurement of calcific plaque on noncontrast computed tomography. Despite the clinical inertia for downstream functional cardiac testing after detecting high CAC, comprehensive ASCVD prevention strategies should be the primary focus for SCD risk reduction.
总结目前关于冠状动脉钙(CAC)和心源性猝死(SCD)风险的证据,并强调未来的研究方向。
虽然高达 80%的 SCD 归因于冠心病(CHD),但有助于改善 SCD 风险预测的亚临床动脉粥样硬化标志物在很大程度上尚不清楚。最近的观察性数据表明,在调整传统危险因素后,随着 CAC 负荷的逐渐增加,SCD 的风险呈阶梯式上升,因此无症状且无明显动脉粥样硬化性心血管疾病(ASCVD)的患者,与 CAC = 0 相比,SCD 风险增加 3 至 5 倍,其 CAC 至少为 100。尽管 CAC 与 SCD 风险增加的机制尚未完全阐明,但心肌梗死和瘢痕的风险,以及/或运动引起的缺血可能是潜在的介导因素。
在无症状的中年人群中,CAC 负荷较高是 SCD 的一个重要危险因素,这表明通过非增强 CT 测量钙化斑块,可以在心源性猝死早期开始进行 CHD 的 SCD 风险分层。尽管在检测到 CAC 较高后,对下游功能性心脏检测的临床惰性较大,但全面的 ASCVD 预防策略应是降低 SCD 风险的主要关注点。