{"title":"心绞痛和非阻塞性冠状动脉患者心外膜冠状动脉痉挛的CT预测因素。","authors":"Takashi Mineo, Eisuke Usui, Yoshihisa Kanaji, Masahiro Hada, Tatsuhiro Nagamine, Hiroki Ueno, Kai Nogami, Mirei Setoguchi, Tomohiro Tahara, Tatsuya Sakamoto, Masahiro Hoshino, Tomoyo Sugiyama, Taishi Yonetsu, Tetsuo Sasano, Tsunekazu Kakuta","doi":"10.1161/CIRCIMAGING.124.017565","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Recent studies have shown that vasospastic angina (VSA) is associated with myocardial bridge (MB) and pericoronary adipose tissue inflammation. We aimed to investigate the clinical and coronary computed tomography angiographic (CCTA) features that could predict VSA in patients with angina and nonobstructive coronary arteries.</p><p><strong>Methods: </strong>We retrospectively studied patients with angina and nonobstructive coronary arteries who underwent a spasm provocation test and CCTA within 3 months before the spasm provocation test. Pericoronary adipose tissue inflammation was evaluated using the fat attenuation index (FAI) of the proximal reference diameter and the inner 2 mm adipose tissue layer (FAI<sub>2mm</sub>) from the vessel wall. Coronary plaques were qualitatively classified as noncalcified or calcified plaques in each vessel. In addition, MB was evaluated in the left anterior descending artery.</p><p><strong>Results: </strong>This study included 142 patients, with 55 (38.7%) diagnosed with VSA. Factors associated with VSA included male sex (74.5% versus 51.7%, <i>P</i>=0.01), smoking history (70.9% versus 52.9%, <i>P</i>=0.05), CCTA-defined MB (49.1% versus 28.7%, <i>P</i>=0.02), and FAI, especially FAI<sub>2mm</sub> in the right coronary artery-FAI<sub>2mm</sub> (-68.8 Hounsfield unit versus -74.0 Hounsfield unit, <i>P</i><0.01), as well as the presence of CCTA-defined mixed or noncalcified plaque anywhere in the coronary tree (65.5% versus 39.1%, <i>P</i><0.01). In a multivariable analysis, CCTA-defined MB (odds ratio, 2.23 [95% CI, 1.03-4.83]; <i>P</i>=0.04), right coronary artery-FAI<sub>2mm</sub> (odds ratio, 1.07 [95% CI, 1.02-1.12]; <i>P</i><0.01), and the presence of mixed or noncalcified plaque (odds ratio, 3.15 [95% CI, 1.45-6.80]; <i>P</i><0.01) were independently associated with VSA. A combination of CCTA-defined MB in the left descending artery, high right coronary artery-FAI<sub>2mm</sub> (≥-72.6 Hounsfield unit, median), and CCTA-defined mixed or noncalcified plaque in the coronary tree predicted VSA with a 75.0% probability, while the absence of all 3 factors precluded VSA with 95.6% probability.</p><p><strong>Conclusions: </strong>For patients with angina and nonobstructive coronary arteries, a prespasm provocation test using a noninvasive comprehensive assessment with CCTA may help identify those at high risk for VSA.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":" ","pages":"e017565"},"PeriodicalIF":6.5000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"CT Predictors of Epicardial Coronary Spasm in Patients With Angina and Nonobstructive Coronary Arteries.\",\"authors\":\"Takashi Mineo, Eisuke Usui, Yoshihisa Kanaji, Masahiro Hada, Tatsuhiro Nagamine, Hiroki Ueno, Kai Nogami, Mirei Setoguchi, Tomohiro Tahara, Tatsuya Sakamoto, Masahiro Hoshino, Tomoyo Sugiyama, Taishi Yonetsu, Tetsuo Sasano, Tsunekazu Kakuta\",\"doi\":\"10.1161/CIRCIMAGING.124.017565\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Recent studies have shown that vasospastic angina (VSA) is associated with myocardial bridge (MB) and pericoronary adipose tissue inflammation. We aimed to investigate the clinical and coronary computed tomography angiographic (CCTA) features that could predict VSA in patients with angina and nonobstructive coronary arteries.</p><p><strong>Methods: </strong>We retrospectively studied patients with angina and nonobstructive coronary arteries who underwent a spasm provocation test and CCTA within 3 months before the spasm provocation test. Pericoronary adipose tissue inflammation was evaluated using the fat attenuation index (FAI) of the proximal reference diameter and the inner 2 mm adipose tissue layer (FAI<sub>2mm</sub>) from the vessel wall. Coronary plaques were qualitatively classified as noncalcified or calcified plaques in each vessel. In addition, MB was evaluated in the left anterior descending artery.</p><p><strong>Results: </strong>This study included 142 patients, with 55 (38.7%) diagnosed with VSA. Factors associated with VSA included male sex (74.5% versus 51.7%, <i>P</i>=0.01), smoking history (70.9% versus 52.9%, <i>P</i>=0.05), CCTA-defined MB (49.1% versus 28.7%, <i>P</i>=0.02), and FAI, especially FAI<sub>2mm</sub> in the right coronary artery-FAI<sub>2mm</sub> (-68.8 Hounsfield unit versus -74.0 Hounsfield unit, <i>P</i><0.01), as well as the presence of CCTA-defined mixed or noncalcified plaque anywhere in the coronary tree (65.5% versus 39.1%, <i>P</i><0.01). In a multivariable analysis, CCTA-defined MB (odds ratio, 2.23 [95% CI, 1.03-4.83]; <i>P</i>=0.04), right coronary artery-FAI<sub>2mm</sub> (odds ratio, 1.07 [95% CI, 1.02-1.12]; <i>P</i><0.01), and the presence of mixed or noncalcified plaque (odds ratio, 3.15 [95% CI, 1.45-6.80]; <i>P</i><0.01) were independently associated with VSA. A combination of CCTA-defined MB in the left descending artery, high right coronary artery-FAI<sub>2mm</sub> (≥-72.6 Hounsfield unit, median), and CCTA-defined mixed or noncalcified plaque in the coronary tree predicted VSA with a 75.0% probability, while the absence of all 3 factors precluded VSA with 95.6% probability.</p><p><strong>Conclusions: </strong>For patients with angina and nonobstructive coronary arteries, a prespasm provocation test using a noninvasive comprehensive assessment with CCTA may help identify those at high risk for VSA.</p>\",\"PeriodicalId\":10202,\"journal\":{\"name\":\"Circulation: Cardiovascular Imaging\",\"volume\":\" \",\"pages\":\"e017565\"},\"PeriodicalIF\":6.5000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation: Cardiovascular Imaging\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCIMAGING.124.017565\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/21 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Cardiovascular Imaging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCIMAGING.124.017565","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/21 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
CT Predictors of Epicardial Coronary Spasm in Patients With Angina and Nonobstructive Coronary Arteries.
Background: Recent studies have shown that vasospastic angina (VSA) is associated with myocardial bridge (MB) and pericoronary adipose tissue inflammation. We aimed to investigate the clinical and coronary computed tomography angiographic (CCTA) features that could predict VSA in patients with angina and nonobstructive coronary arteries.
Methods: We retrospectively studied patients with angina and nonobstructive coronary arteries who underwent a spasm provocation test and CCTA within 3 months before the spasm provocation test. Pericoronary adipose tissue inflammation was evaluated using the fat attenuation index (FAI) of the proximal reference diameter and the inner 2 mm adipose tissue layer (FAI2mm) from the vessel wall. Coronary plaques were qualitatively classified as noncalcified or calcified plaques in each vessel. In addition, MB was evaluated in the left anterior descending artery.
Results: This study included 142 patients, with 55 (38.7%) diagnosed with VSA. Factors associated with VSA included male sex (74.5% versus 51.7%, P=0.01), smoking history (70.9% versus 52.9%, P=0.05), CCTA-defined MB (49.1% versus 28.7%, P=0.02), and FAI, especially FAI2mm in the right coronary artery-FAI2mm (-68.8 Hounsfield unit versus -74.0 Hounsfield unit, P<0.01), as well as the presence of CCTA-defined mixed or noncalcified plaque anywhere in the coronary tree (65.5% versus 39.1%, P<0.01). In a multivariable analysis, CCTA-defined MB (odds ratio, 2.23 [95% CI, 1.03-4.83]; P=0.04), right coronary artery-FAI2mm (odds ratio, 1.07 [95% CI, 1.02-1.12]; P<0.01), and the presence of mixed or noncalcified plaque (odds ratio, 3.15 [95% CI, 1.45-6.80]; P<0.01) were independently associated with VSA. A combination of CCTA-defined MB in the left descending artery, high right coronary artery-FAI2mm (≥-72.6 Hounsfield unit, median), and CCTA-defined mixed or noncalcified plaque in the coronary tree predicted VSA with a 75.0% probability, while the absence of all 3 factors precluded VSA with 95.6% probability.
Conclusions: For patients with angina and nonobstructive coronary arteries, a prespasm provocation test using a noninvasive comprehensive assessment with CCTA may help identify those at high risk for VSA.
期刊介绍：
Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others.
Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.
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