Malek Nayfeh, Mahmoud Al Rifai, Ahmed Ibrahim Ahmed, Faisal Nabi, Mouaz Al-Mallah
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引用次数: 0
Abstract
Background: It is important to evaluate the relationship between coronary plaque characteristics and myocardial blood flow (MBF) to determine coronary phenotypes that may predispose to cardiovascular disease.
Objectives: To study the association between coronary artery calcium (CAC) volume and density and positron emission tomography (PET)-derived myocardial flow reserve (MFR) and their relationship with incident cardiovascular disease.
Methods: The study population consisted of consecutive patients who were referred for clinically indicated PET myocardial perfusion imaging between 2019 and 2024. CAC was assessed in a separate gated scan done just prior to PET and calculated using the Agatston score. Since the Agatston score includes calcified plaques (≥130 HU), soft and low-density plaques were not assessed. MFR was calculated as the ratio of stress to rest MBF. Patients with CAC=0 and those with known CAD were excluded.
Results: The study population consisted of 3,884 individuals with mean (SD) age 69 (±10.5) years. When CAC volume and density were included in the same model, CAC density was positively associated with MFR (β coefficient= 0.10, 95% CI 0.06, 0.15) and CAC volume was inversely associated (β coefficient -0.08, 95% CI -0.10, -0.05). During a median follow-up of 13.7 months, the primary outcome (death/myocardial infarction) occurred in 218 individuals (5.6%). When CAC volume and density were included in the same model including demographics and cardiovascular risk factors, CAC density was inversely and significantly associated with the primary outcome (HR= 0.67, 95% CI 0.47, 0.96) while CAC volume was positively and significantly associated with it (HR= 1.57, 95% CI 1.34, 1.82). Results were no longer significant after further adjustment for CAC, stress test parameters and MFR.
Conclusion: At any level of CAC volume, higher CAC density is significantly associated with higher MFR but not associated with risk of death/myocardial infarction.
背景：评估冠状动脉斑块特征与心肌血流量（MBF）之间的关系对于确定可能易患心血管疾病的冠状动脉表型非常重要。目的：探讨冠状动脉钙（CAC）体积和密度与正电子发射断层扫描（PET）心肌血流储备（MFR）的关系及其与心血管疾病的关系。方法：研究人群包括2019年至2024年间转诊进行临床适应症PET心肌灌注显像的连续患者。CAC在PET之前进行单独的门控扫描评估，并使用Agatston评分计算。由于Agatston评分包括钙化斑块（≥130 HU），因此不评估软斑块和低密度斑块。MFR计算为应力与静息MBF之比。排除CAC=0和已知CAD的患者。结果：研究人群包括3884名个体，平均（SD）年龄为69（±10.5）岁。当将CAC体积和密度纳入同一模型时，CAC密度与MFR呈正相关（β系数= 0.10,95% CI 0.06, 0.15）， CAC体积呈负相关（β系数-0.08,95% CI -0.10, -0.05）。在中位13.7个月的随访期间，218人（5.6%）出现主要结局（死亡/心肌梗死）。当将CAC体积和密度纳入包括人口统计学和心血管危险因素在内的同一模型时，CAC密度与主要结局呈显著负相关（HR= 0.67, 95% CI 0.47, 0.96），而CAC体积与主要结局呈正相关（HR= 1.57, 95% CI 1.34, 1.82）。在进一步调整CAC、压力测试参数和MFR后，结果不再显著。结论：在任何CAC体积水平下，较高的CAC密度与较高的MFR显著相关，但与死亡/心肌梗死风险无关。
期刊介绍：
European Heart Journal – Cardiovascular Imaging is a monthly international peer reviewed journal dealing with Cardiovascular Imaging. It is an official publication of the European Association of Cardiovascular Imaging, a branch of the European Society of Cardiology.
The journal aims to publish the highest quality material, both scientific and clinical from all areas of cardiovascular imaging including echocardiography, magnetic resonance, computed tomography, nuclear and invasive imaging. A range of article types will be considered, including original research, reviews, editorials, image focus, letters and recommendation papers from relevant groups of the European Society of Cardiology. In addition it provides a forum for the exchange of information on all aspects of cardiovascular imaging.
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