Abstract

Introduction

A family history of premature CAD may promote enhanced development of coronary atherosclerosis in a sibling population. Baseline CV algorithms may underestimate the risk of coronary incidents in individuals at familial risk. Cardiac CT provides high diagnostic performance for the detection of coronary plaques. There is little data on the use of this technology in the initial diagnostic approach of these patients. The prognostic value of early detection of coronary plaques by cardiac CT remains unknown in this population.

Objectives

The study aimed to estimate the global CV risk and the pre-test probability of CAD in patients with a family history of premature CAD. We investigated the potential role of cardiac CT imaging in the assessment of coronary risk in patients from high-risk families. We sought to remind the 2019 ESC guidelines for screening for CAD in asymptomatic subjects.

Methods

Fifty siblings of patients with premature CAD were investigated. The pre-test probability of CAD was determined with the Clinical Model of the CAD consortium. The risk of CV disease was calculated and compared with three different risk algorithms (SCORE, FRS, PROCAM). All patients underwent cardiac CT with both non-contrast and contrast imaging. Coronary artery calcium (CAC) scoring was calculated and CT angiograms were analyzed. Patients with suspected CT obstructive CAD underwent coronary angiography. Clinical outcomes in terms of treatment were analyzed.

Results

The pre-test probability of CAD was low: CAD consortium <10% in 60%, SCORE <5% in 100%, FRS <10% in 88%, CAC scoring <100% in 68%. However, PROCAM was <10% in 16 cases (32%). Only 12 patients (24%) presented normal CCTA findings. In patients with abnormal CCTA findings (n = 38), PROCAM was higher than FRS in 20 patients (53%). Coronary angiography was performed in 31 cases (62%) for suspected CT obstructive CAD. Most patients presented no significant lesions (55%). Revascularization was performed in 8 patients (16%), 6 of them (75%) presented CAC scoring <100, 4 of them (50%) presented CAC scoring <400. After investigation, lipid-lowering therapy was enhanced by 66%.

Conclusion

Coronary atherosclerotic-phenotyping using cardiac CT may provide discriminatory information allowing earlier identification of patients at familial risk of premature CAD. This diagnostic workup strategy may help to guide and improve the management of these patients. However, there is a paucity of data concerning the prognostic significance of this technology in relatives at familial risk of premature CAD. Therefore, further randomized controlled trials are needed to assess the incremental risk-predictive value of this approach in this population.

中文翻译：

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早发 CAD 家族史患者的心脏 CT 检查结果：一项观察性研究

摘要

介绍

早发 CAD 的家族史可能会促进兄弟姐妹中冠状动脉粥样硬化的发展。基线 CV 算法可能低估了有家族风险的个人发生冠状动脉事件的风险。心脏 CT 为检测冠状动脉斑块提供了高诊断性能。关于在这些患者的初始诊断方法中使用该技术的数据很少。通过心脏 CT 早期检测冠状动脉斑块的预后价值在该人群中仍然未知。

目标

该研究旨在评估具有早发 CAD 家族史的患者的总体 CV 风险和 CAD 的预测试概率。我们研究了心脏 CT 成像在评估高危家庭患者冠心病风险中的潜在作用。我们试图提醒 2019 年 ESC 指南，以筛查无症状受试者的 CAD。

方法

对 50 名早发 CAD 患者的兄弟姐妹进行了调查。CAD 的预测试概率由 CAD 联盟的临床模型确定。计算了 CV 疾病的风险，并与三种不同的风险算法（SCORE、FRS、PROCAM）进行了比较。所有患者都接受了非对比和对比成像的心脏 CT。计算冠状动脉钙 (CAC) 评分并分析 CT 血管造影照片。疑似 CT 阻塞性 CAD 的患者接受了冠状动脉造影。分析了治疗方面的临床结果。

结果

CAD 的预测试概率低：CAD 联合体 <10% 占 60%，SCORE <5% 占 100%，FRS <10% 占 88%，CAC 得分 <100% 占 68%。然而，在 16 例 (32%) 中，PROCAM <10%。只有 12 名患者 (24%) 表现出正常的 CCTA 检查结果。在 CCTA 结果异常的患者中 ( n  = 38)，PROCAM 高于 FRS 的患者有 20 名 (53%)。31 例 (62%) 疑似 CT 阻塞性 CAD 行冠状动脉造影。大多数患者没有出现明显的病变 (55%)。8 名患者 (16%) 进行了血运重建，其中 6 名 (75%) 的 CAC 评分 <100，其中 4 名 (50%) 的 CAC 评分 <400。经调查，降脂治疗提高了66%。

结论

使用心脏 CT 进行的冠状动脉粥样硬化表型分析可能会提供鉴别信息，从而可以更早地识别出具有早发 CAD 家族风险的患者。这种诊断检查策略可能有助于指导和改善这些患者的管理。然而，关于这项技术对有家族性早发 CAD 风险的亲属的预后意义的数据很少。因此，需要进一步的随机对照试验来评估这种方法在该人群中的增量风险预测价值。