通过冠状动脉计算机断层扫描血管造影术 (CCTA) 提高血管特异性心肌缺血的诊断准确性。

Marta Belmonte, Pasquale Paolisso, Emanuele Gallinoro, Dario Tino Bertolone, Attilio Leone, Giuseppe Esposito, Serena Caglioni, Michele Mattia Viscusi, Konstantinos Bermpeis, Tatyana Storozhenko, Eric Wyffels, Joseph Bartunek, Jeroen Sonck, Carlos Collet, Daniele Andreini, Marc Vanderheyden, Martin Penicka, Emanuele Barbato
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引用次数: 0

摘要

背景:冠状动脉计算机断层扫描(CCTA)评估的狭窄严重程度与缺血之间的差异可能取决于血管类型。冠状动脉斑块特征与缺血相关。因此,我们评估了 CCTA 导出的直径狭窄(DS)与有创分数血流储备(FFR)的血管特异性相关性,并探讨了按血管分层整合形态斑块特征是否能提高识别血管特异性缺血的预测率:观察性队列研究,包括因疑似冠状动脉疾病接受CCTA检查的患者,CCTA检查时至少有一根血管的DS≥50%,接受有创冠状动脉造影和FFR检查。斑块分析使用经过验证的半自动软件进行。冠状动脉血管被分为左前降支(LAD)、左环挠(LCX)和右冠状动脉(RCA)。通过单变量和多变量逻辑回归分析,检验了 CCTA 导出的解剖学和形态学斑块特征中每条血管缺血的独立预测因素。预测缺血的最佳临界值由尤登指数决定。缺血的定义是FFR≤0.80:研究对象包括 192 名患者,其中 224 条血管(61 % LAD、19 % LCX、20 % RCA)的病变 DS ≥ 50 %。尽管DS相似,但与LCX和RCA相比,LAD的FFR≤0.80率更高(分别为67.2% vs 43.2%和44.2%,p = 0.018)。仅在 LAD 观察到 DS 与 FFR 之间存在明显相关性(p = 0.003)。在按血管分层的多变量分析中,血管特异性的 FFR 阳性独立预测因子是 LAD 的粥样斑块体积百分比(阈值>17%)、LCX 的非钙化斑块体积(阈值>130 mm3)和 RCA 的管腔体积(阈值 3)。与单独使用 DS 相比,整合 DS 和血管特异性形态斑块特征可显著提高缺血的预测率(AUC 从 0.51 到 0.63 再到 0.76-0.80):结论:与单独使用 DS 相比,整合 DS 和血管特异性形态斑块特征可显著提高血管特异性缺血的预测率,从而改善患者转诊至导管室的情况。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Improved diagnostic accuracy of vessel-specific myocardial ischemia by coronary computed tomography angiography (CCTA).

Background: Discrepancies between stenosis severity assessed at coronary computed tomography angiography (CCTA) and ischemia might depend on vessel type. Coronary plaque features are associated with ischemia. Thus, we evaluated the vessel-specific correlation of CCTA-derived diameter stenosis (DS) and invasive fractional flow reserve (FFR) and explored whether integrating morphological plaque features stratified by vessel might increase the predictive yield in identifying vessel-specific ischemia.

Methods: Observational cohort study including patients undergoing CCTA for suspected coronary artery disease, with at least one vessel with DS ​≥ ​50 ​% at CCTA, undergoing invasive coronary angiography and FFR. Plaque analysis was performed using validated semi-automated software. Coronary vessels were stratified in left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA). Per vessel independent predictors of ischemia among CCTA-derived anatomical and morphologic plaque features were tested at univariable and multivariable logistic regression analysis. The best cut-off to predict ischemia was determined by Youden's index. Ischemia was defined by FFR≤0.80.

Results: The study population consisted of 192 patients, of whom 224 vessels (61 ​% LAD, 19 ​% LCX, 20 ​% RCA) had lesions with DS ​≥ ​50 ​% interrogated by FFR. Despite similar DS, the rate of FFR≤0.80 was higher in the LAD compared to LCX and RCA (67.2 ​% vs 43.2 ​% and 44.2 ​%, respectively, p ​= ​0.018). A significant correlation between DS and FFR was observed only in LAD (p ​= ​0.003). At multivariable analysis stratified by vessel, the vessel-specific independent predictors of positive FFR were percent atheroma volume (threshold>17 ​%) for LAD, non-calcified plaque volume (threshold >130 ​mm3) for LCX, and lumen volume (threshold <844 ​mm3) for RCA. Integrating DS and vessel-specific morphological plaque features significantly increased the predictive yield for ischemia compared to DS alone (AUC ranging from 0.51 to 0.63 to 0.76-0.80).

Conclusions: Integrating DS and vessel-specific morphological plaque features significantly increased the predictive yield for vessel-specific ischemia compared to DS alone, potentially improving patients' referral to the catheterization laboratory.

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