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Sinnvolle Diagnostik: Bildgebung

Meaningful diagnostics: imaging

Zusammenfassung

Die Bildgebung der subklinischen Atherosklerose wird in einem präventivmedizinischen Algorithmus auf der Grundlage einer vorausgehenden kardiovaskulären Risikostratifikation eingebunden. Für eine weitergehende Bildgebung qualifizieren sich insbesondere Patienten mit niedrigem und intermediärem Risiko (cave: Bayes-Theorem). Die bildgebenden Verfahren bei der subklinischen Atherosklerose haben eines gemeinsam: Sie bilden die Atherosklerose direkt ab, wofür sich die kardiale Mehrschichtcomputertomographie (MSCT; koronares Kalzium-Scoring [CACS]) und der Ultraschall der Gefäße (Arteria carotis und/oder femoralis) zum Nachweis der Plaque-Last eignen. Der Befund wird als ein „risk modifier“ betrachtet. Die Risikoabschätzung ist nicht an Symptomatik gebunden. Neben der Aufdeckung und Lokalisierung der Atherosklerose erlaubt sie auch die Bestimmung des „Risikoalters“ nach den Tabellen der European Society of Cardiology (ESC) und sogar des biologischen Alters, welches anhand von Nomogrammen abgeschätzt werden kann. Diese Kenntnisse tragen dazu bei, die Compliance des Patienten und die Adhärenz zur Medikation zu fördern.

Abstract

Imaging of subclinical atherosclerosis is an integrated component of a preventive medicine algorithm; i.e. on the basis of a cardiovascular risk stratification patients with a low and intermediate risk qualify for further imaging (cave: Bayesʼ theorem). Imaging procedures for subclinical atherosclerosis have one thing in common: atherosclerosis is detected and localized directly, for which cardiac multidetector computed tomography (MDCT; coronary calcium scoring, CACS) and vascular ultrasound (carotid and/or femoral arteries) are used to measure the plaque burden. The result is viewed as a risk modifier. The risk assessment is not related to symptoms. In addition to the detection and localization of atherosclerosis this also enables assessment of the “risk age” according to the tables of the European Society of Cardiology (ESC) and even the biological age, which can be estimated based on nomograms. This knowledge can be used to promote patient compliance and adherence to medication.

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Literatur

  1. 1.

    Greenland P, Alpert JS, Beller GA et al (2010) ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults. A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. Circulation 2010(122):e584–e636

  2. 2.

    Nixdorff U (2009) Herz-Kreislauf-Check-Up. In: Nixdorff U (Hrsg) Check-Up-Medizin. Prävention von Krankheiten – Evidenz-basierte Empfehlungen für die Praxis. Thieme, Stuttgart, New York, S 28–48

  3. 3.

    Piepoli MF, Hoes AW, Agewall S et al (2016) European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016(37):2315–2381

  4. 4.

    Mach F, Baigent C, Catapano AL et al (2019) ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Atherosclerosis 2019(290):140–205

  5. 5.

    Francesco C, Grant JP, Aboyans V et al (2019) 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. https://doi.org/10.1093/eurheartj/ehz486

  6. 6.

    Perk J, Gohlke H, de Backer G et al (2012) European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J 33:1635–1701

  7. 7.

    Scholl J, Bots ML, Peters SA (2015) Contribution of cardiorespiratory fitness, relative to traditional cardiovascular disease risk factors, to common carotid intima-media thickness. J Intern Med 277:439–446

  8. 8.

    Shai I, Spence JD, Schwarzfuchs D et al (2010) Dietary intervention to reverse carotid atherosclerosis. Circulation 121:1200–1208

  9. 9.

    Mureddu GF, Brandimarte F, Faggiano P et al (2013) Between risk charts and imaging: how should we stratify cardiovascular risk in clinical practice? Eur Heart J Cardiovasc Imaging 14(5):401–416

  10. 10.

    Dawber TR, Kannel WB (1958) An epidemiologic study of heart disease: the Framingham study. Nutr Rev 16:1–4

  11. 11.

    Assmann G, Cullen P, Schulte H (2002) Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the Prospective Cardiovascular Munster (PROCAM) study. Circulation 105:310–315

  12. 12.

    Arnett DK, Blumenthal RS, Albert MA et al (2019) ACC/AHA Guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019(140):596–646

  13. 13.

    Pencina MJ, D’Agostino RB Sr, D’Agostino RB Jr, Vasan RS (2008) Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med 27:157–172

  14. 14.

    Nixdorff U, Achenbach S, Bengel F et al (2015) Imaging in cardiovascular prevention. The ESC Textbook of Preventive Cardiology. Oxford University Press, Oxford, S 54–76

  15. 15.

    Naghavi M, Falk E, Hecht HS et al (2006) From vulnerable plaque to vulnerable patient—Part III: executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) task force report. Am J Cardiol 98:2H–15H

  16. 16.

    Erbel R, Budoff M (2012) Improvement of cardiovascular risk prediction using coronary imaging: subclinical atherosclerosis: the memory of lifetime risk factor exposure. Eur Heart J 33:1201–1217

  17. 17.

    Erbel R, Möhlenkamp S, Jöckel KH et al (2008) Cardiovascular risk factors and signs of subclinical atherosclerosis in the Heinz Nixdorf Recall Study. Dtsch Arztebl Int 105(1–2):1–8

  18. 18.

    Dykun I, Lehmann N, Kälsch H et al (2016) Statin medication enhances progression of coronary artery calcification: the Heinz Nixdorf recall study. J Am Coll Cardiol 68:2123–2125

  19. 19.

    Lee JM, Choi KH, Koo BK et al (2019) Prognostic implications of plaque characteristics and Stenosis severity in patients with coronary artery disease. J Am Coll Cardiol 73:2413–2424

  20. 20.

    Daida H, Dohl T, Fukushima Y et al (2019) The goal of achieving atherosclerotic plaque regressing with lipid-lowering therapy: insights from IVUS trials. J Atheroscler Thromb 26:592–600

  21. 21.

    Erbel R, Möhlenkamp S, Moebus S et al (2010) Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol 56:1397–1406

  22. 22.

    Detrano R, Guerci AD, Carr JJ et al (2008) Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 358:1336–1345

  23. 23.

    Han D, Beecy A, Anchouche K et al (2019) Risk reclassification with coronary computed Tomography angiography-visualized nonobstructive coronary artery disease according to 2018 American College of Cardiology/American Heart Association Cholesterol guidelines (from the coronary computed Tomography Angiography evaluation for clinical outcomes : an international multicenter registry [CONFIRM]). Am J Cardiol 124:1397–1405

  24. 24.

    Knuuti J, Wijns W, Saraste A et al (2019) 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndroms. Eur Heart J. https://doi.org/10.1093/eurheartj/ehz425

  25. 25.

    Newby DE, Adamson PD, Berry C et al (2018) The SCOT-HEART Investigators. Coronary CT angiography and 5‑year risk of myocardial infarction. N Engl J Med 379:924–933

  26. 26.

    Nilsson PM, Boutouyrie P, Laurent S (2009) Vascular aging: a tale of EVA and ADAM in cardiovascular risk assessment and prevention. Hypertension 54:3–10

  27. 27.

    Wong ND, Detrano RC, Diamond G et al (1996) Does coronary artery screening by electron beam computed tomography motivate potentially beneficial lifestyle behaviours? Am J Cardiol 78:1220–1223

  28. 28.

    Dichgans M, Malik R, König IR et al (2014) Shared genetic susceptibility to ischemic stroke and coronary artery disease: a genome-wide analysis of common variants. Stroke 45(1):24–36

  29. 29.

    Glagov S, Weisenberg E, Zarins CK et al (1987) Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 316(22):1371–1375

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Author information

Correspondence to Prof. Dr. med. Uwe Nixdorff FESC.

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Interessenkonflikt

U. Nixdorff gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Nixdorff, U. Sinnvolle Diagnostik: Bildgebung. Herz 45, 17–23 (2020). https://doi.org/10.1007/s00059-020-04890-7

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Schlüsselwörter

  • Atherosklerose
  • Kardiovaskuläre Bildgebung
  • Koronares Kalzium-Scoring
  • Karotisultraschall
  • Compliance

Keywords

  • Atherosclerosis
  • Cardiovascular imaging
  • Coronary calcium scoring
  • Carotid ultrasound
  • Compliance