Variations in common carotid artery intima-media thickness during the cardiac cycle: implications for cardiovascular risk assessment.
Variations in common carotid artery intima-media thickness during the cardiac cycle: implications for cardiovascular risk assessment.
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DOI：
10.1016/j.echo.2012.05.007
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发表时间：
2012-09
影响因子：
6.5
通讯作者：
D'Agostino, Ralph B.
中科院分区：
文献类型：
--
作者：
Polak, Joseph F.;Meisner, Allison;Pencina, Michael J.;Wolf, Philip A.;D'Agostino, Ralph B.
颈总动脉（CCA）内膜-中膜厚度（cIMT）是动脉粥样硬化的测量指标，在收缩期峰值（PS）和舒张末期（ED）之间变化。这种差异可能会影响心血管风险评估。左右CCA的IMT测量与心电图同步：r波为ED， t波为PS。在Framingham后代研究的2930名成员中测量了IMT。以ED-IMT、PS-IMT和IMT变化为因变量，Framingham危险因素为自变量，建立多变量回归模型。根据PS获得的规范数据，将ED-IMT估计值与IMT的上四分位数进行比较。我们的人口平均年龄为57.9岁。心周期内IMT的平均差异为0.037 mm （95% CI: 0.035-0.038 mm）。ED-IMT和PS-IMT与Framingham危险因素的相关性相似（总R2= 0.292比0.275），且与所有危险因素均显著相关。在一个完全调整的多变量模型中，收缩期峰值时较薄的IMT与脉压（p < 0.0001）、低密度脂蛋白胆固醇（p = 0.0064）、年龄（p = 0.046）相关，而没有其他危险因素。在使用上四分位数PS-IMT规范数据的同时进行ED-IMT测量，导致第四个IMT四分位数（心血管高风险类别）的个体数量不恰当地增加了42.1%。收缩期峰值和舒张末期的IMT差异与脉压、低密度脂蛋白胆固醇和年龄有关。在我们的研究中，心脏周期的平均IMT差异导致42.1%的心血管疾病高危人群高估了IMT。
Common carotid artery (CCA) intima-media thickness (cIMT), a measure of atherosclerosis, varies between peak-systole (PS) and end-diastole (ED). This difference might affect cardiovascular risk assessment. IMT measurements of the right and left CCA were synchronized with an electrocardiogram: R-wave for ED and T-wave for PS. IMT was measured in 2930 members of the Framingham Offspring Study. Multivariable regression models were generated with ED-IMT, PS-IMT and change in IMT as dependent variables and Framingham risk factors as independent variables. ED-IMT estimates were compared to the upper quartile of IMT based on normative data obtained at PS. The average age of our population was 57.9 years. Average difference in IMT during the cardiac cycle was 0.037 mm (95% CI: 0.035–0.038 mm). ED-IMT and PS-IMT had similar associations with Framingham risk factors (total R2= 0.292 versus 0.275) and were significantly associated with all risk factors. In a fully adjusted multivariable model, a thinner IMT at peak-systole was associated with pulse pressure (p < 0.0001), LDL-cholesterol (p = 0.0064), age (p = 0.046), and no other risk factors. Performing ED-IMT measurements while using upper quartile PS-IMT normative data lead to inappropriately increasing by 42.1% the number of individuals in the fourth IMT quartile (high cardiovascular risk category). The difference in IMT between peak-systole and end-diastole is associated with pulse pressure, LDL-cholesterol, and age. In our study, mean IMT difference during the cardiac cycle lead to an overestimation by 42.1% of individuals at high risk for cardiovascular disease.
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