Carotid artery plaque morphology and composition in relation to incident cardiovascular events: the Multi-Ethnic Study of Atherosclerosis (MESA).
Carotid artery plaque morphology and composition in relation to incident cardiovascular events: the Multi-Ethnic Study of Atherosclerosis (MESA).
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DOI：
10.1148/radiol.14131020
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发表时间：
2014-02
期刊：
影响因子：
19.7
通讯作者：
A. Zavodni;B. Wasserman;R. McClelland;A. Gomes;A. Folsom;J. Polak;J. Lima;D. Bluemke
中科院分区：
文献类型：
--
作者：
A. Zavodni;B. Wasserman;R. McClelland;A. Gomes;A. Folsom;J. Polak;J. Lima;D. Bluemke
目的：通过磁共振（MR）成像确定颈动脉斑块的形态和成分是否可用于识别无症状受试者的心血管事件风险。材料和方法每个研究中心的机构审查委员会批准了这项研究，所有研究中心都符合健康保险携带和责任法案（HIPAA）。共有946名参与者在多种族研究的动脉粥样硬化（梅萨）进行了评估与磁共振成像和超声检查（美国）。MR成像用于确定颈动脉斑块组成和重塑指数（壁面积除以壁面积和管腔面积之和），而US用于评估颈动脉壁厚度。事件心血管事件，包括心肌梗死，心脏骤停复苏，心绞痛，中风和死亡，平均为5.5年。确定了事件预测的多变量考克斯比例风险模型、C统计量和净重新分类改善（NRI）。结果59例（6%）参与者发生心血管事件。在单变量分析中，颈动脉IMT以及MR成像重构指数、脂质核心和颈内动脉钙是事件的显著预测因素（所有P <0.001）。对于传统风险因素，事件预测的C统计量为0.696。对于MR成像重构指数和脂质核心，C统计量为0.734，有和无心血管事件的参与者的NRI分别为7.4%和15.8%（P = 0.02）。除传统危险因素外，美国IMT的NRI不显著。结论MR成像识别易损斑块特征有助于心血管疾病的预测，并改善基线心血管风险的重新分类。
PURPOSE To determine if carotid plaque morphology and composition with magnetic resonance (MR) imaging can be used to identify asymptomatic subjects at risk for cardiovascular events. MATERIALS AND METHODS Institutional review boards at each site approved the study, and all sites were Health Insurance Portability and Accountability Act (HIPAA) compliant. A total of 946 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) were evaluated with MR imaging and ultrasonography (US). MR imaging was used to define carotid plaque composition and remodeling index (wall area divided by the sum of wall area and lumen area), while US was used to assess carotid wall thickness. Incident cardiovascular events, including myocardial infarction, resuscitated cardiac arrest, angina, stroke, and death, were ascertained for an average of 5.5 years. Multivariable Cox proportional hazards models, C statistics, and net reclassification improvement (NRI) for event prediction were determined. RESULTS Cardiovascular events occurred in 59 (6%) of participants. Carotid IMT as well as MR imaging remodeling index, lipid core, and calcium in the internal carotid artery were significant predictors of events in univariate analysis (P < .001 for all). For traditional risk factors, the C statistic for event prediction was 0.696. For MR imaging remodeling index and lipid core, the C statistic was 0.734 and the NRI was 7.4% and 15.8% for participants with and those without cardiovascular events, respectively (P = .02). The NRI for US IMT in addition to traditional risk factors was not significant. CONCLUSION The identification of vulnerable plaque characteristics with MR imaging aids in cardiovascular disease prediction and improves the reclassification of baseline cardiovascular risk.