不同程度动脉粥样硬化造成的胸主动脉结构和功能紊乱

IF 0.5 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Kardiologiya Pub Date : 2023-12-05 DOI:10.18087/cardio.2023.11.n2315

A V Vrublevsky, A A Boshchenko, Yu I Bogdanov, V V Saushkin, O L Shnaider

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In the descending TA, the global peak systolic circumferential strain (GCS, %) and the global peak systolic circumferential strain normalized to pulse arterial pressure (PAP) (GCS / PAP∙100) were calculated. All patients underwent coronary angiography. The number of coronary arteries (CAs) with >50 % stenosis was determined, and the SYNTAX Score was calculated.Results TA atherosclerosis was not detected in the control group. Among 182 patients, stage 1-5 TA atherosclerosis was found in 23 (12.6 %), 103 (56.6 %), 43 (23.6 %), 7 (3.8 %), and 6 (3.4 %) cases respectively. GCS and GCS / PAD decreased as the ultrasound stage of TA atherosclerosis increased as compared with the control group: 9.2 % and 15.3 for the control group; stage 1, 5.6 % and 8.9 (p<0.001); stage 2, 4.1 % and 5.9 (p<0.001); stage 3, 4 % and 5.8 (p<0.001); stage 4, 3.7 % and 4.9 (p<0.01); and stage 5, 2.6 % and 3.3 (p<0.01), respectively. ROC analysis showed that GCS ≥5.9 % (area under the curve, AUC, 0.94±0.03; p<0.001) and GCS / PAD ≥11.4 (AUC, 0.97±0.02; p <0.001) were predictors of intact TA. Also, GCS ≤4.85 % (AUC, 0.82±0.04; p<0.001) and GCS / PAD ≤8.06 (AUC, 0.87±0.03; p<0.001) were predictors of hemodynamically significant TA atherosclerosis (stages 3-5). GCS ≤4.05 % (AUC, 0.62±0.04; p=0.007) and GCS / PAD ≤5.95 (AUC, 0.61±0.04; p=0.018) were predictors of hemodynamically significant (>50 %) stenosing atherosclerosis of at least one CA. Furthermore, GCS ≤3.75 % (AUC, 0.67±0.07; p=0.039) and GCS / PAD ≤5.15 (AUC, 0.64±0.07; p=0.045) were predictors of severe and advanced coronary atherosclerosis (SYNTAX Score ≥22).Conclusion GCS and GCS / PAD are new diagnostic markers of structural and functional disorders of TA in atherosclerosis of various grades. GCS and GCS / PAD are independent predictors of high-grade TA atherosclerosis (stages 3-5) with GCS / PAD demonstrating the highest level of significance. 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引用次数: 0

摘要

目的使用二维斑点追踪经食道超声心动图研究正常情况下和不同程度的动脉粥样硬化时主动脉周向应变的总体情况，并确定其在预测胸主动脉（TA）和冠状动脉粥样硬化的结构和功能紊乱方面的作用。对照组由 11 名健康志愿者组成。对 TA 的全长进行观察。测量每个粥样斑块的高度，并确定 TA 中斑块的总数。确定了 TA 粥样硬化的五个阶段。在降支TA中，计算了收缩期周向应变总体峰值（GCS，%）和与脉搏动脉压（PAP）归一化的收缩期周向应变总体峰值（GCS / PAP∙100）。所有患者均接受了冠状动脉造影术。结果对照组未发现 TA 动脉粥样硬化。在 182 例患者中，发现 1-5 期 TA 粥样硬化的病例分别为 23 例（12.6%）、103 例（56.6%）、43 例（23.6%）、7 例（3.8%）和 6 例（3.4%）。与对照组相比，随着 TA 动脉粥样硬化超声分期的增加，GCS 和 GCS / PAD 均有所下降：对照组分别为9.2%和15.3；1期为5.6%和8.9（p<0.001）；2期为4.1%和5.9（p<0.001）；3期为4%和5.8（p<0.001）；4期为3.7%和4.9（p<0.01）；5期为2.6%和3.3（p<0.01）。ROC分析显示，GCS≥5.9 %（曲线下面积，AUC，0.94±0.03；p<0.001）和GCS/PAD≥11.4（AUC，0.97±0.02；p<0.001）是TA完好的预测因子。此外，GCS ≤4.85 %（AUC，0.82±0.04；p<0.001）和 GCS / PAD ≤8.06 （AUC，0.87±0.03；p<0.001）是血流动力学显著 TA 动脉粥样硬化（3-5 期）的预测因子。GCS≤4.05%（AUC，0.62±0.04；p=0.007）和GCS/PAD≤5.95（AUC，0.61±0.04；p=0.018）是至少一个CA的血流动力学显著性（>50%）狭窄性动脉粥样硬化的预测因子。此外，GCS ≤ 3.75 %（AUC，0.67±0.07；p=0.039）和 GCS / PAD ≤ 5.15（AUC，0.64±0.07；p=0.045）是严重和晚期冠状动脉粥样硬化（SYNTAX 评分≥22）的预测指标。GCS和GCS/PAD可独立预测高级别TA动脉粥样硬化（3-5期），其中GCS/PAD的显著性最高。GCS和GCS/PAD是严重和晚期CA动脉粥样硬化的无创预测指标。

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Structural and Functional Disturbances of the Thoracic Aorta in Atherosclerosis of Various Gradations.

Aim To study global aortic circumferential strain in normal conditions and in atherosclerosis of various grades and to determine its role in prediction of structural and functional disorders of the thoracic aorta (TA) and coronary atherosclerosis using 2D speckle-tracking transesophageal echocardiography.Material and methods 182 patients with typical or probable angina were examined. The control group consisted of 11 healthy volunteers. TA was visualized along its entire length. The height of each atheroma was measured, and the total number of plaques in the TA was determined. Five stages of TA atherosclerosis were identified. In the descending TA, the global peak systolic circumferential strain (GCS, %) and the global peak systolic circumferential strain normalized to pulse arterial pressure (PAP) (GCS / PAP∙100) were calculated. All patients underwent coronary angiography. The number of coronary arteries (CAs) with >50 % stenosis was determined, and the SYNTAX Score was calculated.Results TA atherosclerosis was not detected in the control group. Among 182 patients, stage 1-5 TA atherosclerosis was found in 23 (12.6 %), 103 (56.6 %), 43 (23.6 %), 7 (3.8 %), and 6 (3.4 %) cases respectively. GCS and GCS / PAD decreased as the ultrasound stage of TA atherosclerosis increased as compared with the control group: 9.2 % and 15.3 for the control group; stage 1, 5.6 % and 8.9 (p<0.001); stage 2, 4.1 % and 5.9 (p<0.001); stage 3, 4 % and 5.8 (p<0.001); stage 4, 3.7 % and 4.9 (p<0.01); and stage 5, 2.6 % and 3.3 (p<0.01), respectively. ROC analysis showed that GCS ≥5.9 % (area under the curve, AUC, 0.94±0.03; p<0.001) and GCS / PAD ≥11.4 (AUC, 0.97±0.02; p <0.001) were predictors of intact TA. Also, GCS ≤4.85 % (AUC, 0.82±0.04; p<0.001) and GCS / PAD ≤8.06 (AUC, 0.87±0.03; p<0.001) were predictors of hemodynamically significant TA atherosclerosis (stages 3-5). GCS ≤4.05 % (AUC, 0.62±0.04; p=0.007) and GCS / PAD ≤5.95 (AUC, 0.61±0.04; p=0.018) were predictors of hemodynamically significant (>50 %) stenosing atherosclerosis of at least one CA. Furthermore, GCS ≤3.75 % (AUC, 0.67±0.07; p=0.039) and GCS / PAD ≤5.15 (AUC, 0.64±0.07; p=0.045) were predictors of severe and advanced coronary atherosclerosis (SYNTAX Score ≥22).Conclusion GCS and GCS / PAD are new diagnostic markers of structural and functional disorders of TA in atherosclerosis of various grades. GCS and GCS / PAD are independent predictors of high-grade TA atherosclerosis (stages 3-5) with GCS / PAD demonstrating the highest level of significance. GCS and GCS / PAD are non-invasive predictors of severe and advanced CA atherosclerosis.

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来源期刊

Kardiologiya 医学-心血管系统

CiteScore

1.70

自引率

20.00%

发文量

审稿时长

3-8 weeks

期刊介绍： “Kardiologiya” (Cardiology) is a monthly scientific, peer-reviewed journal committed to both basic cardiovascular medicine and practical aspects of cardiology. As the leader in its field, “Kardiologiya” provides original coverage of recent progress in cardiovascular medicine. We publish state-of-the-art articles integrating clinical and research activities in the fields of basic cardiovascular science and clinical cardiology, with a focus on emerging issues in cardiovascular disease. Our target audience spans a diversity of health care professionals and medical researchers working in cardiovascular medicine and related fields. The principal language of the Journal is Russian, an additional language – English (title, authors’ information, abstract, keywords). “Kardiologiya” is a peer-reviewed scientific journal. All articles are reviewed by scientists, who gained high international prestige in cardiovascular science and clinical cardiology. The Journal is currently cited and indexed in major Abstracting & Indexing databases: Web of Science, Medline and Scopus. The Journal''s primary objectives Contribute to raising the professional level of medical researchers, physicians and academic teachers. Present the results of current research and clinical observations, explore the effectiveness of drug and non-drug treatments of heart disease, inform about new diagnostic techniques; discuss current trends and new advancements in clinical cardiology, contribute to continuing medical education, inform readers about results of Russian and international scientific forums; Further improve the general quality of reviewing and editing of manuscripts submitted for publication; Provide the widest possible dissemination of the published articles, among the global scientific community; Extend distribution and indexing of scientific publications in major Abstracting & Indexing databases.