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Erschienen in: Herz 1/2020

30.01.2020 | Schwerpunkt

Sinnvolle Diagnostik: Bildgebung

verfasst von: FESC Prof. Dr. med. Uwe Nixdorff

Erschienen in: Herz | Ausgabe 1/2020

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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.
Literatur
1.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 CrossRef 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 CrossRef
4.
Zurück zum Zitat 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 CrossRef 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 CrossRef
6.
Zurück zum Zitat 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 CrossRef 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 CrossRef
7.
Zurück zum Zitat 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 CrossRef 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 CrossRef
8.
Zurück zum Zitat Shai I, Spence JD, Schwarzfuchs D et al (2010) Dietary intervention to reverse carotid atherosclerosis. Circulation 121:1200–1208 CrossRef Shai I, Spence JD, Schwarzfuchs D et al (2010) Dietary intervention to reverse carotid atherosclerosis. Circulation 121:1200–1208 CrossRef
9.
Zurück zum Zitat 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 CrossRef 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 CrossRef
10.
Zurück zum Zitat Dawber TR, Kannel WB (1958) An epidemiologic study of heart disease: the Framingham study. Nutr Rev 16:1–4 CrossRef Dawber TR, Kannel WB (1958) An epidemiologic study of heart disease: the Framingham study. Nutr Rev 16:1–4 CrossRef
11.
Zurück zum Zitat 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 CrossRef 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 CrossRef
12.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 CrossRef 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 CrossRef
14.
Zurück zum Zitat 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 CrossRef 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 CrossRef
15.
Zurück zum Zitat 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 CrossRef 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 CrossRef
16.
Zurück zum Zitat 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 CrossRef 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 CrossRef
17.
Zurück zum Zitat 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 PubMedPubMedCentral 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 PubMedPubMedCentral
18.
Zurück zum Zitat 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 CrossRef 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 CrossRef
19.
Zurück zum Zitat 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 CrossRef 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 CrossRef
20.
Zurück zum Zitat 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 CrossRef 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 CrossRef
21.
Zurück zum Zitat 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 CrossRef 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 CrossRef
22.
Zurück zum Zitat 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 CrossRef 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 CrossRef
23.
Zurück zum Zitat 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 CrossRef 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 CrossRef
25.
Zurück zum Zitat 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 CrossRef 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 CrossRef
26.
Zurück zum Zitat 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 CrossRef 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 CrossRef
27.
Zurück zum Zitat 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 CrossRef 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 CrossRef
28.
Zurück zum Zitat 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 CrossRef 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 CrossRef
29.
Zurück zum Zitat Glagov S, Weisenberg E, Zarins CK et al (1987) Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 316(22):1371–1375 CrossRef Glagov S, Weisenberg E, Zarins CK et al (1987) Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 316(22):1371–1375 CrossRef
Metadaten
Titel
Sinnvolle Diagnostik: Bildgebung
verfasst von
FESC Prof. Dr. med. Uwe Nixdorff
Publikationsdatum
30.01.2020
Verlag
Springer Medizin
Erschienen in
Herz / Ausgabe 1/2020
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI
https://doi.org/10.1007/s00059-020-04890-7