Article, see p 1993 The clinician now has an overwhelming array of investigations at his or her disposal for patients with suspected coronary heart disease. These tests are used to diagnose or risk-stratify patients and thereby enable the clinician to treat their symptoms and reduce their future risk. Ultimately, these investigations either assess risk factors (eg, lipid, glucose, and C-reactive protein concentrations) and proxies for disease (eg, carotid intima-media thickness and coronary artery calcium score) or are looking to provide circumstantial downstream evidence of disease (eg, markers of ischemia and infarction: Q waves on an ECG, fibrosis on magnetic resonance imaging or functional stress testing). In this issue of Circulation , Budoff and colleagues1 compare 2 of the most widely used approaches, coronary artery calcium scoring and functional stress testing, within the framework of the PROMISE trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain). Coronary artery calcification is considered pathognomonic of atherosclerosis and has been a marker of coronary artery disease for millennia.2 Its presence is, however, a proxy of disease because it is induced in response to atherosclerosis, and, apart from rare calcific nodules, calcification does not directly cause ischemic heart disease events. Indeed, calcification appears to be an adaptive healing response to the necrotic atheromatous plaque whereby the body attempts to limit and contain the disease, much like the calcification of a caseating granuloma from mycobacterium tuberculosis infection. However, calcification does not directly relate to the degree of luminal or functional stenosis of the coronary artery, nor does it necessarily reflect the current status of the plaque because the calcification may be inactive, ongoing, or incomplete. Indeed, large areas of inert macrocalcification are associated with plaque stability, whereas spotty calcifications or microcalcifications are associated with high-risk plaques, probably because of incomplete calcification.3– …

中文翻译：

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计算机断层扫描或功能性压力测试可预测风险

文章，见第1993页。对于可疑的冠心病患者，临床医生现在可以进行大量的检查。这些测试用于诊断患者或对患者进行风险分层，从而使临床医生能够治疗其症状并降低其未来风险。最终，这些研究要么评估风险因素（例如，脂质，葡萄糖和C反应蛋白浓度）和疾病的代表（例如，颈动脉内膜中层厚度和冠状动脉钙化评分），要么希望提供疾病的间接下游证据（例如，缺血和梗塞的标志物：心电图上的Q波，磁共振成像或功能性压力测试时的纤维化）。在本期《循环》中，Budoff和同事1比较了两种使用最广泛的方法，在PROMISE试验（用于评估胸痛的前瞻性多中心影像研究）的框架内进行冠状动脉钙化评分和功能性压力测试。冠状动脉钙化被认为是动脉粥样硬化的病因，是数千年来冠状动脉疾病的标志。2但是，它的存在是疾病的一种替代，因为它是对动脉粥样硬化的反应所致，除了罕见的钙化结节外，钙化确实不直接引起缺血性心脏病事件。的确，钙化似乎是对坏死的动脉粥样斑块的适应性愈合反应，因此人体试图限制和控制该疾病，就像结核分枝杆菌感染引起的干酪型肉芽肿的钙化一样。然而，钙化与冠状动脉腔或功能性狭窄的程度没有直接关系，也不一定反映斑块的当前状态，因为钙化可能是无效的，进行中的或不完整的。实际上，大面积的惰性宏观钙化与斑块稳定性有关，而斑点钙化或微钙化与高风险斑块有关，这可能是由于钙化不完全所致。3–…