Bershtein L L, Boldueva S A, Kochanov I N, Lunina M D, Naiden T V, Evdokimov D S, Tandelov B M, Podmetin P S, Zbyshevskaya E V, Gumerova V E, Savinova E B, Piltakyan V H, Sayganov S A
Mechnikov North-Western State Medical University, St-Petersburg.
Municipal Pokrov Hospital, St-Petersburg.
Kardiologiia. 2023 Sep 30;63(9):20-28. doi: 10.18087/cardio.2023.9.n2460.
Aim Analysis of inter- and intra-study variability of changes in the atherosclerotic plaque (ASP) total height and total area, the main quantitative indexes that were planned to be used in the present study for assessment of the atherosclerotic load of carotid arteries.Material and methods The incidence of recurrent cardiovascular complications (CVC) within 1 year after acute coronary syndrome (ACS) ranges from 7-9 % (in studies) to 34 % (in clinical practice). This indicates insufficient efficacy of traditional approaches to secondary prevention of coronary heart disease. We proposed a study to test a hypothesis that the dynamics of ASP parameters in carotid and subclavian regions can serve as an alternative criterion for the adequacy of secondary prevention after ACS. The analysis was performed on subgroups of main study participants. These patients had ACS of any type documented by coronary angiography with an ASP confirmed by ultrasound of the brachiocephalic arteries (BCA) during the index hospitalization. BCA ultrasound was performed to analyze the inter- and intra-study variability of BCA atherosclerotic load, the ASP total height (Hsum) and total area (ASPTA), in 20 and 24 patients of the main study, respectively. Results of the repeated ultrasound were evaluated in 30 patients of the main study after 6 months of follow-up.Results The inter-study variability of each index was significantly higher than the intra-study variability which was consistent with results of previous studies. The intra-study variability of Hsum was 0.10 (95 % confidence interval, CI - 0.23-0.44) mm and ASPTA, 1.05 (95 % CI, - 0.54-2.63) mm2. The variability values were considerably smaller than the changes for 6 months: Hsum, 0.92 (95 % CI, - 0.64-2.49) mm and ASPTA, 3.67 (95 % CI, 0.42-6.91) mm2, although the difference did not reach statistical significance. The above results were obtained at an early stage of the study during the adaptation of specialists to the protocol.Conclusion The study results suggest a possibility of a fairly reliable assessment of the dynamics of quantitative indexes of carotid ultrasound 6 months after ACS.
分析动脉粥样硬化斑块（ASP）总高度和总面积变化的组内和组间变异性，这些是本研究中计划用于评估颈动脉粥样硬化负荷的主要定量指标。
急性冠状动脉综合征（ACS）后 1 年内复发性心血管并发症（CVC）的发生率为 7-9%（研究中）至 34%（临床实践中）。这表明传统的冠心病二级预防方法的疗效不足。我们提出了一项研究，以检验以下假设：颈动脉和锁骨下区域 ASP 参数的变化可以作为 ACS 后二级预防充分性的替代标准。该分析在主要研究参与者的亚组中进行。这些患者的任何类型的 ACS 均通过冠状动脉造影记录，并在指数住院期间通过肱动脉（BCA）的超声检查证实存在 ASP。进行 BCA 超声检查以分析 20 名和 24 名主要研究患者的 BCA 动脉粥样硬化负荷、ASP 总高度（Hsum）和总面积（ASPTA）的组内和组间变异性。在主要研究的 30 名患者中，在 6 个月的随访后评估了重复超声的结果。
每个指数的组间变异性明显高于组内变异性，这与以前的研究结果一致。Hsum 的组内变异性为 0.10（95%置信区间，CI-0.23-0.44）mm，ASPTA 为 1.05（95%CI-0.54-2.63）mm2。与 6 个月的变化相比，这些值要小得多：Hsum 为 0.92（95%CI-0.64-2.49）mm，ASPTA 为 3.67（95%CI 0.42-6.91）mm2，尽管差异无统计学意义。上述结果是在研究的早期阶段获得的，当时专家正在适应方案。
研究结果表明，在 ACS 后 6 个月，对颈动脉超声定量指标的动态变化进行相当可靠的评估是可能的。
