Gałąska Rafał, Kulawiak-Gałąska Dorota, Dorniak Karolina, Stróżyk Aneta, Sabisz Agnieszka, Chmara Magdalena, Wasąg Bartosz, Mickiewicz Agnieszka, Rynkiewicz Andrzej, Fijałkowski Marcin, Gruchała Marcin
1st Department of Cardiology, Medical University of Gdansk, 80-210 Gdansk, Poland.
Department of Radiology, Medical University of Gdansk, 80-210 Gdansk, Poland.
J Clin Med. 2023 Aug 27;12(17):5589. doi: 10.3390/jcm12175589.
We aimed to compare the extent of subclinical atherosclerosis in the ascending and descending aortas by measuring wall area and thickness using 3D cardiovascular magnetic resonance imaging (aAWAI and dAWAI) in patients with asymptomatic familial hypercholesterolemia (FH) and nonfamilial hypercholesterolemia (NFH). We also aimed to establish the interrelations of CMR parameters with other subclinical atherosclerosis measurements, such as calcium scores, obtained using computed tomography in coronary arteries (CCS) and ascending and descending aorta (TCSasc and TCSdsc), as well as the carotid intima-media thicknesses (cIMT) using ultrasonography. A total of 60 patients with FH (29 men and 31 women), with a mean age of 52.3 ± 9.6 years, were analyzed. A subclinical atherosclerosis assessment was also performed on a group consisting of 30 age- and gender-matched patients with NFH, with a mean age of 52.5 ± 7.9 years. We found the ascending and descending aortic wall areas and thicknesses in the FH group to be significantly increased than those of the NFH group. A multivariate logistic regression analysis showed that a positive FH mutation value was a strong predictor of high aAWAI and dAWAI independent of the LDL cholesterol level. Correlations across CMR atherosclerotic parameters, calcium scores, and cIMT in the FH and NFH groups, were significant but low. Most of the atherosclerosis tests with high results belonged to the FH group. We found that patients with documented heterozygous FH had a higher atherosclerosis burden in the aorta compared to patients with severe hypercholesterolemia without FH gene mutation. Atherosclerosis is not severe in asymptomatic patients with FH, but is more pronounced and also more diffuse than in patients with NFH. The etiology of hypercholesterolemia, and not just cholesterol levels, plays a significant role in determining the degree of subclinical atherosclerosis.
我们旨在通过三维心血管磁共振成像测量升主动脉和降主动脉的壁面积和厚度（分别为aAWAI和dAWAI），比较无症状家族性高胆固醇血症（FH）和非家族性高胆固醇血症（NFH）患者亚临床动脉粥样硬化的程度。我们还旨在确定心脏磁共振成像（CMR）参数与其他亚临床动脉粥样硬化测量指标之间的相互关系，如使用计算机断层扫描获得的冠状动脉钙化积分（CCS）以及升主动脉和降主动脉钙化积分（TCSasc和TCSdsc），以及使用超声检查获得的颈动脉内膜中层厚度（cIMT）。共分析了60例FH患者（29例男性和31例女性），平均年龄为52.3±9.6岁。还对一组由30例年龄和性别匹配的NFH患者组成的对照组进行了亚临床动脉粥样硬化评估，其平均年龄为52.5±7.9岁。我们发现FH组的升主动脉和降主动脉壁面积及厚度均显著高于NFH组。多因素逻辑回归分析显示，FH突变阳性值是高aAWAI和dAWAI的强预测因子，独立于低密度脂蛋白胆固醇水平。FH组和NFH组中CMR动脉粥样硬化参数、钙化积分和cIMT之间的相关性显著但较低。大多数检测结果较高的动脉粥样硬化检测属于FH组。我们发现，与无FH基因突变的严重高胆固醇血症患者相比，有记录的杂合子FH患者主动脉的动脉粥样硬化负担更高。无症状FH患者的动脉粥样硬化并不严重，但比NFH患者更明显且更弥漫。高胆固醇血症的病因，而不仅仅是胆固醇水平，在决定亚临床动脉粥样硬化程度方面起着重要作用。
