独立于供应商的冠状动脉评分改善了个人风险评估:MESA (动脉样硬化多民族研究)
Niels R van der Werf1, Magdalena M Dobrolinska2, Marcel J W Greuter2
1Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
JACC. Cardiovascular imaging
|June 15, 2023
概括
经销商中立的阿加斯顿分数 (vnAS) 提高了冠心病风险预测. 一个新的校准工具将11%的患者重新分类到一个更高风险组,然后显示出显著更高的心脏事件率.
科学领域:
- 心脏病学 心脏病学
- 放射学 放射学是一门学科.
- 医疗成像医学成像
背景情况:
- 阿加斯顿分数 (AS) 在计算机断层扫描 (CT) 扫描仪之间有显著差异,可能会影响冠心病 (CHD) 患者风险分类.
- 标准化风险评估对于准确的患者管理和治疗决策至关重要.
研究的目的:
- 开发一个校准工具,用于创建适用于现代CT系统的供应商中立的Agatston分数 (vnAS).
- 评估 vnAS 对冠心病 (CHD) 事件预测的影响.
主要方法:
- 使用7个CT系统和1个电子束断层扫描 (EBT) 系统 (参考) 上成像的人形幻象开发了一个校准工具.
- 动脉样硬化多民族研究 (MESA) 队列 (3181名参与者) 用于评估vnas对心血管疾病事件预测的影响.
- 采用了奇平方分析和多变量考克斯比例危险回归模型.
主要成果:
- 在CT衍生的AS和EBT-AS之间观察到强烈的相关性 (R2>0.932).
- 使用vnAS,最初在低组中的11%的参与者被重新分类到更高风险类别.
- 被重新分类的参与者具有显著更高的CHD事件率 (15%与7%) 和CHD事件的更高危险比率 (3.39).
结论:
- 一个新的校准工具成功生成了供应商中立的Agatston分数 (vnAS).
- 实施vnAS导致冠心病风险分类的改善.
- 使用vnAS重新分类到更高类别的患者经历了更多的CHD事件,证实了预测准确度的提高.
相关概念视频
Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
42
Calcium-Scoring CT ScanA calcium-scoring CT scan, also known as coronary artery calcium (CAC) scan, detects calcium deposits in the coronary arteries. This test assesses the risk of coronary artery disease (CAD), which can lead to cardiovascular events such as angina, heart failure, and sudden cardiac arrest.A calcium-scoring CT scan is generally recommended for individuals at intermediate risk of CAD without symptoms. It includes:Men aged 40-75 and women aged 50-75: Especially those with a...
42
Acute Coronary Syndrome III: Diagnostic Studies
11
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
11
Imaging Studies for Cardiovascular System V: CT
45
Cardiac computed tomography (CT) scanning is an advanced cardiac imaging technique that utilizes CT technology, with or without intravenous (IV) contrast, to produce accurate cross-sectional virtual slices of specific areas of the heart, coronary circulation, and major blood vessels such as the aorta, pulmonary veins, and arteries. The computer processes these slices to generate three-dimensional images. Multidetector CT (MDCT) is a rapid form of CT scanning that captures multiple slices...
45
Coronary Artery Disease V: Interprofessional Care
11
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
11
Coronary Artery Disease IV: Preventive Measures
25
Effective preventive measures for coronary artery disease (CAD) focus on controlling modifiable risk factors, including cholesterol abnormalities and lifestyle changes.Cholesterol ManagementFirst, the Mediterranean diet and the American Heart Association advocate for maintaining low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, with a more stringent recommendation of below 70 mg/dL for individuals at high risk. LDL cholesterol, often termed "bad cholesterol," can lead to the...
25
Acute Coronary Syndrome I: Introduction
33
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
33


