基于cta的冠状动脉AI斑块定量在经导管主动脉瓣植入术患者中的预后价值

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology Pub Date : 2025-10-04 DOI:10.1016/j.ejrad.2025.112445

Kifah Hussain , Kevin Lee , Senthil S. Balasubramanian , Lavisha Singh , Natasha Vyas , Fazal Hussain , Lucas Wathen , Mark J. Ricciardi , Jonathon Leipsic , Campbell Rogers , David Davidson , Amit Pursnani

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引用次数: 0

摘要

背景：冠状动脉疾病可以作为经导管主动脉瓣置入术（TAVI）前CT血管造影（CTA）的一部分进行评估。最近，可以对冠状动脉CT血管造影（CCTA）进行定量斑块分析。在这项研究中，我们旨在通过人工智能量化冠状动脉斑块分析（AI-QCPA）在tavi前CTA上评估定量斑块体积的预后价值。方法本观察性队列研究纳入了接受CTA进行TAVI计划并同时评估冠状动脉粥样硬化的患者。研究在192层双源SIEMENS Force CT扫描仪上进行，未给予硝酸甘油或β受体阻滞剂等预用药。我们检查了伴有AI-QCPA的TAVI患者的冠状动脉斑块特征，并评估了一年内发生重大心脏不良事件（MACE）的患者与未发生MACE的患者斑块体积的差异。MACE定义为tavi后1年内全因死亡率、卒中、心肌梗死、心力衰竭住院或计划外血运重建术的综合。结果128例患者行ai - qcpa，平均年龄80.1 ± 9.6 岁（男性51.6% %）。共有24例患者在1 年发生MACE。发生MACE的患者中位总斑块体积（TPV）、钙化斑块体积（CPV）、非钙化斑块体积（NCPV）和低衰减斑块体积（LAPV）均显著升高。调整胸外科学会（STS）评分、他汀类药物使用和tavi前血运重建的多变量回归分析显示，NCPV最高四分位数（OR 4.56, 95 % CI 1.61-12.89; p = 0.004）和LAPV （OR 3.70, 95 % CI 1.29-10.60; p = 0.015）与MACE独立相关。当考虑冠状动脉狭窄时，总斑块和所有斑块亚型与MACE独立相关。结论AI-QCPA评估的TAVI患者冠脉斑块体积较高，与TAVI术后1年MACE的发生独立相关。

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Prognostic value of coronary CTA-based AI plaque quantification in patients undergoing transcatheter aortic valve implantation

Background

Coronary artery disease can be concomitantly evaluated as part of the pre-transcatheter aortic valve implantation (TAVI) CT angiography (CTA). More recently it has been possible to perform quantitative plaque analysis on coronary CT angiography (CCTA). In this study, we aimed to assess the prognostic value of quantitative plaque volumes using Artificial Intelligence Quantified Coronary Plaque Analysis (AI-QCPA) on pre-TAVI CTA.

Methods

This observational cohort study included patients who underwent CTA for TAVI planning with concomitant evaluation for coronary atherosclerosis. Studies were performed on a 192-slice dual-source SIEMENS Force CT scanner without administration of pre-medication such as nitroglycerin or beta-blockers. We examined coronary plaque characteristics in TAVI patients with AI-QCPA and assessed differences in plaque volumes between patients who developed major adverse cardiac events (MACE) at one year versus those who did not. MACE was defined as a composite of all-cause mortality, stroke, myocardial infarction, heart failure hospitalization, or unplanned revascularization within 1-year post-TAVI.

Results

AI-QCPA was performed in 128 patients, with mean age of 80.1 ± 9.6 years (51.6 % male). A total of 24 patients developed MACE at 1 year. Median total plaque volume (TPV), calcified plaque volume (CPV), non-calcified plaque volume (NCPV), and low-attenuation plaque volume (LAPV) were significantly higher in patients who developed MACE. Multivariable regression analysis adjusting for Society of Thoracic Surgeons (STS) score, statin use, and revascularization pre-TAVI, showed that the highest quartile of NCPV (OR 4.56, 95 % CI 1.61–12.89; p = 0.004) and LAPV (OR 3.70, 95 % CI 1.29–10.60; p = 0.015) were independently associated with MACE. When adjusted for coronary stenosis total plaque and all plaque subtypes were independently associated with MACE.

Conclusion

There is high volume of coronary plaque in patients undergoing TAVI assessed by AI-QCPA which is independently associated with the development of MACE one year post-TAVI.

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来源期刊

European Journal of Radiology 医学-核医学

CiteScore

6.70

自引率

3.00%

发文量

398

审稿时长

42 days

期刊介绍： European Journal of Radiology is an international journal which aims to communicate to its readers, state-of-the-art information on imaging developments in the form of high quality original research articles and timely reviews on current developments in the field. Its audience includes clinicians at all levels of training including radiology trainees, newly qualified imaging specialists and the experienced radiologist. Its aim is to inform efficient, appropriate and evidence-based imaging practice to the benefit of patients worldwide.