Arnăutu Sergiu Florin, Morariu Vlad Ioan, Arnăutu Diana Aurora, Tomescu Mirela Cleopatra
Neurology Department, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania.
Multidisciplinary Heart Research Center, Victor Babes University of Medicine and Pharmacy, 300040 Timisoara, Romania.
Rev Cardiovasc Med. 2022 Apr 13;23(4):146. doi: 10.31083/j.rcm2304146. eCollection 2022 Apr.
The goal of this study is to see if carotid strain and strain rate can predict major cardio-vascular events (MACE) in people who have metabolic syndrome (MS) over a 3-year period of time.
In this prospective observational research, we enrolled 220 adult MS patients (60.7 7.5 years old, 53% male). Two-dimensional common carotid carotid artery (CCA) speckle-tracking ultrasound was used to determine the peak circumferential strain (CS) and the peak circumferential strain rate (CSR). Clinical outcomes were assessed throughout a three-year follow-up period.
After a 3-year follow-up period follow-up, 14 (7%) experienced MACE: Eight (4%) suffered an atherothrombotic ischemic stroke, four (2%) had acute coronary syndrome, and two (1%) were hospitalized for heart failure. Univariate regression analysis of the clinical and echocardiographic features of the MS patients found that age, systemic hypertension, diabetes mellitus, and the CCA circumferential strain and strain rate were significantly associated with the risk of MACE. Multivariate logistic regression identified two independent predictors of MACE in patients with MS, namely the CCA-related CS (%) and CSR (1/s), 0.01. The Receiver operating characteristic (ROC) curve analyses of these independent predictors of MACE indicated appropriate sensitivities and specificities. CS (AUC = 0.806, sensitivity = 82.6%, specificity = 79.2%, 0.0001) and CSR (AUC = 0.779, sensitivity = 82.6%, specificity = 72.4%, 0.0001) with cut-off values of 2.9% for carotid CS and 0.35 for carotid CSR. Using these cut-off values, we obtained Kaplan-Meier survival curves, and these showed that MACE, ischemic stroke, and ACS-free survival was significantly lower among the MS patients with lower carotid CS and CSR ( 0.0001).
Carotid CS and CSR were independent predictors of major cardio- and cerebro-vascular events in prospectively monitored MS patients without established cardiovascular disease. Carotid deformation could be valuable as an early prognostic indicator for the cardiovascular risk in this population group.
本研究旨在探讨在3年时间内，颈动脉应变和应变率能否预测代谢综合征（MS）患者发生主要心血管事件（MACE）的情况。
在这项前瞻性观察研究中，我们纳入了220例成年MS患者（年龄60.7±7.5岁，男性占53%）。采用二维颈总动脉（CCA）斑点追踪超声测定峰值圆周应变（CS）和峰值圆周应变率（CSR）。在三年的随访期内评估临床结局。
经过3年的随访，14例（7%）发生了MACE：其中8例（4%）发生动脉粥样硬化性缺血性卒中，4例（2%）发生急性冠状动脉综合征，2例（1%）因心力衰竭住院。对MS患者的临床和超声心动图特征进行单因素回归分析发现，年龄、系统性高血压、糖尿病以及CCA圆周应变和应变率与MACE风险显著相关。多因素逻辑回归确定了MS患者中MACE的两个独立预测因素，即与CCA相关的CS（%）和CSR（1/s），P<0.01。对这些MACE独立预测因素的受试者工作特征（ROC）曲线分析显示出适当的敏感性和特异性。CS（AUC = 0.806，敏感性 = 82.6%，特异性 = 79.2%，P<0.0001）和CSR（AUC = 0.779，敏感性 = 82.6%，特异性 = 72.4%，P<0.0001），颈动脉CS的临界值为-2.9%，颈动脉CSR的临界值为-0.35。使用这些临界值，我们绘制了Kaplan-Meier生存曲线，结果显示，颈动脉CS和CSR较低的MS患者发生MACE及无缺血性卒中和急性冠状动脉综合征生存的概率显著降低（P<0.0001）。
在未患心血管疾病的前瞻性监测MS患者中，颈动脉CS和CSR是主要心脑血管事件的独立预测因素。颈动脉变形作为该人群心血管风险的早期预后指标可能具有重要价值。
