Aortic Root Calcification Score as an Independent Factor for Predicting Major Adverse Cardiac Events in Familial Hypercholesterolemia.
Aortic Root Calcification Score as an Independent Factor for Predicting Major Adverse Cardiac Events in Familial Hypercholesterolemia.
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DOI：
10.5551/jat.42705
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发表时间：
2018-07-01
影响因子：
4.4
通讯作者：
Kawashiri MA
中科院分区：
文献类型：
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作者：
Okada H;Tada H;Hayashi K;Kawashima H;Takata T;Sakata K;Nohara A;Mabuchi H;Yamagishi M;Kawashiri MA
目的：本研究的目的是：1）确定使用冠状动脉计算机断层扫描血管造影术（CCTA）评估的主动脉根部钙化（ARC）的累积是否可以预测未来的心血管事件，2）估计家族性高胆固醇血症（FH）患者ARC的发生和进展。研究方法：回顾性评价了113例连续日本杂合子FH患者（男性= 54，平均年龄= 52.1 ± 15.6岁，平均LDL-C = 299.0 ± 94.6 mg/dL），无已知冠状动脉疾病，接受了64排探测器CCTA。ARC定义为主动脉根部存在钙。ARC的范围以Agatston单位表示为ARC评分。主要心脏不良事件（MACE）定义为心源性死亡、ST段抬高型心肌梗死（STEMI）、非ST段抬高型心肌梗死（NSTEMI）、不稳定型心绞痛（UAP）、计划的经皮冠状动脉介入治疗（PCI）、冠状动脉旁路移植术（CABG）或卒中。使用多变量logistic回归分析估计MACE的时间。结果：在随访期间（中位数1635天），发生了19例MACE。多变量逻辑回归分析显示，ARC是MACE的重要独立预测因素（OR= 1.48; 95%CI分别为1.11-1.87，p < 0.001）。男性的回归方程为Y= 0.09X-1.59（R2 = 0.34，p < 0.001），男性为Y = 0.08X-1.60（R2 = 0.13，p <0.001）。05)在女性中。结论：ARC与日本杂合子FH患者未来的MACE显著相关。ARC可能开始发展，平均，在17.4和19.7岁的男性和女性，分别与杂合子FH。
Aim: The aims of this study were: 1) to determine whether the accumulation of aortic root calcification (ARC) assessed using coronary computed tomography angiography (CCTA) can predict future cardiovascular events, and 2) to estimate the onset and progression of ARC in patients with familial hypercholesterolemia (FH). Methods: One hundred thirteen consecutive Japanese patients with heterozygous FH (male = 54, mean age = 52.1 ± 15.6 years, mean LDL-C = 299.0 ± 94.6 mg/dL), without known coronary artery disease, who underwent 64-detector row CCTA were retrospectively evaluated. ARC was defined as the presence of calcium at the aortic root. The extent of ARC was expressed in Agatston units as the ARC-score. Major adverse cardiac events (MACE) were defined as either cardiac death, ST elevated myocardial infarction (STEMI), non-ST elevated myocardial infarction (NSTEMI), unstable angina pectoris (UAP), planned percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or stroke. The periods to MACE were estimated using multivariate logistic regression analysis. Results: During the follow-up period (median 1635 days), 19 instances of MACE occurred. Multivariate logistic regression analysis revealed that ARC was a significant independent predictor of MACE (OR= 1.48; 95% CI 1.11–1.87, p < 0.001, respectively). The regression equations were Y= 0.09X − 1.59 (R2 = 0.34, p < 0.001) in males and Y = 0.08X − 1.60 (R2 = 0.13, p < 0. 05) in females. Conclusions: ARC was significantly associated with future MACE in Japanese patients with heterozygous FH. ARC may start to develop, on average, at 17.4 and 19.7 years of age in males and females, respectively, with heterozygous FH.