Belcaro G, Geroulakos G, Laurora G, Cesarone M R, de Sanctis M T, Incandela L, Barsotti A, Nicolaides A N
Cardiovascular Institute, Chieti University, Italy.
J Cardiovasc Surg (Torino). 1994 Apr;35(2):123-8.
Noninvasive screening of subclinical atherosclerosis is possible with ultrasonic biopsy (UB) performed with high resolution ultrasound scanning. Five UB classes have been identified, each class corresponding to a different incidence of cardiovascular events (CVE) in 4 years and silent coronary ischemia (SCI). In a study including 2230 asymptomatic subjects 3 risk groups were defined. In the low risk group (class I and II; 82.01% of the population sample) the incidence of CVE and SCI was zero. These subjects may be seen again after 3 years. In the moderate risk group (class II and IV; 13.3%) monitoring and early intervention may be needed. In the high risk group (class V; 4.6%) prophylaxis or treatment may be necessary. The screening is effective, simple and may be organised at very low cost--i.e. 30.000 asymptomatic subjects may be scanned at the cost of 100.000 ECU. Each scan, including carotid and femoral bifurcations, may be performed in 15 minutes. In our communities this cost is equivalent to the average cost of a single major stroke or major coronary ischemic event in a working adult aging between 45 and 60. Organization problems and the fragmentation of competences has prevented the evolution of atherosclerosis screening. The problem can be solved organising a network including epidemiologists, angiologists and cardiovascular surgical centres where all phases of atherosclerosis may be studied and detected, progression prevented and complications treated with a global vision of the disease.
使用高分辨率超声扫描进行超声活检（UB）可以对亚临床动脉粥样硬化进行无创筛查。已确定了5种UB类别，每种类别对应4年内不同的心血管事件（CVE）发生率和无症状性冠状动脉缺血（SCI）发生率。在一项纳入2230名无症状受试者的研究中，定义了3个风险组。在低风险组（I类和II类；占总体样本的82.01%）中，CVE和SCI的发生率为零。这些受试者可在3年后再次检查。在中度风险组（III类和IV类；13.3%）中，可能需要进行监测和早期干预。在高风险组（V类；4.6%）中，可能需要进行预防或治疗。这种筛查有效、简单，而且成本极低——例如，以100000欧洲货币单位的成本可以对30000名无症状受试者进行扫描。每次扫描，包括颈动脉和股动脉分叉处，可在15分钟内完成。在我们的社区，这笔费用相当于一名45至60岁在职成年人发生一次重大中风或重大冠状动脉缺血事件的平均费用。组织问题和权限分散阻碍了动脉粥样硬化筛查的发展。通过组织一个包括流行病学家、血管病学家和心血管外科中心的网络可以解决这个问题，在这个网络中，可以从整体角度研究和检测动脉粥样硬化的各个阶段，预防其进展并治疗并发症。
