Matangi Murray F, Hétu Marie-France, Armstrong David W J, Shellenberger Jonas, Brouillard Daniel, Baker Josh, Johnson Ana, Willms Hannah, Johri Amer M
The Kingston Heart Clinic, 460 Princess St, Kingston, Ontario, Canada K7L 1C2.
Department of Medicine, Queen's University, Cardiovascular Imaging Network at Queen's (CINQ), 76 Stuart Street, KGH FAPC 3, Kingston, Ontario, Canada K7L 2V7.
Eur Heart J Open. 2025 Jun 2;5(3):oeaf065. doi: 10.1093/ehjopen/oeaf065. eCollection 2025 May.
Stress echocardiography (SE), though widely accessible, has some limitations in its diagnostic test characteristics for predicting major adverse cardiovascular events (MACEs). Carotid plaque score provides direct detection of subclinical atherosclerosis and can be integrated into the stress protocol. The aim of our study was to assess the value of adding a carotid plaque score to SE to enhance the test diagnostics for predicting MACE in low-intermediate-risk patients.
Patients aged 40-75 years referred for SE received a carotid ultrasound and were followed for 5-year MACE. Hard MACE was defined as a composite of cardiovascular death, non-fatal stroke or myocardial infarction, and emergency coronary revascularization. Soft MACE included non-emergency coronary revascularization. Patients aged >75 years, on a statin, with previously known vascular disease, a history of stroke, myocardial infarction, vascular intervention, or a resting wall motion abnormality on a baseline echo were excluded. Administrative data holdings housed at the Institute of Clinical Evaluative Sciences, ICES, were used for event follow-up. Of the 2588 patients, there were 49 cumulative incidence hard MACE and 119 soft MACE. Carotid plaque score improved the sensitivity of SE for predicting 1- and 5-year MACE. A plaque score threshold value of ≥2 provided clear differentiation of patients who experienced MACE in both positive and non-positive (negative/inconclusive for ischaemia) SE results.
Plaque score enhances diagnostic test characteristics of SE. The combination of carotid ultrasound with SE is an important new tool for cardiovascular risk assessment. This simple tool may help differentiate risk in patients with non-positive SE results.
负荷超声心动图（SE）虽然广泛应用，但在预测主要不良心血管事件（MACE）的诊断测试特征方面存在一些局限性。颈动脉斑块评分可直接检测亚临床动脉粥样硬化，并可纳入负荷检查方案。我们研究的目的是评估在SE基础上增加颈动脉斑块评分以增强预测低中危患者MACE的测试诊断价值。
40 - 75岁接受SE检查的患者接受了颈动脉超声检查，并随访5年的MACE情况。严重MACE定义为心血管死亡、非致死性卒中或心肌梗死以及急诊冠状动脉血运重建的综合情况。轻度MACE包括非急诊冠状动脉血运重建。年龄>75岁、正在服用他汀类药物、既往有已知血管疾病、有卒中、心肌梗死、血管介入病史或基线超声心动图显示静息壁运动异常的患者被排除。利用临床评估科学研究所（ICES）保存的管理数据进行事件随访。在2588例患者中，累积发生严重MACE 49例，轻度MACE 119例。颈动脉斑块评分提高了SE预测1年和5年MACE的敏感性。斑块评分阈值≥2可明确区分SE结果为阳性和非阳性（缺血阴性/不确定）的MACE发生患者。
斑块评分增强了SE的诊断测试特征。颈动脉超声与SE相结合是心血管风险评估的重要新工具。这个简单的工具可能有助于区分SE结果为非阳性患者的风险。
