目的 探讨基于冠状动脉CT血管造影(coronary CT angiography,CCTA)构建的斑块特征指数对稳定性冠心病(coronary artery disease,CAD)患者病变特异性心肌缺血的预测价值.方法 前瞻性地纳入2020年10月至2022年3月于复旦大学附属中山医院收治的稳定性CAD患者90例,包括狭窄程度在30%～90%的目标血管135支.所有患者2周内均接受了CCTA、侵入性冠脉造影和有创血流储备分数(fractional flow reserve,FFR)测量.根据有无血流动力学显著性狭窄,分为心肌缺血人群(FFR≤0.80,n=30)和非缺血人群(FFR＞0.8,n=60),将135 支目标血管分为病变特异性心肌缺血组(FFR≤0.8,n=36)和非病变特异性心肌缺血组(FFR＞0.8,n=99).采用单因素和多因素logistic回归分析诊断病变特异性心肌缺血的影响因素,并建立基于CCTA的斑块特征指数的回归模型.采用ROC曲线分析基于CCTA的斑块特征指数对稳定性CAD患者病变特异性心肌缺血的预测效能.结果 心肌缺血人群与非缺血人群在年龄、体质量指数、性别、心血管危险因素、药物治疗史方面差异均无统计学意义.与非缺血组相比,心肌缺血组的斑块长度、斑块面积、面积狭窄百分比、动脉粥样硬化斑块总体积、血管体积、脂质斑块体积水平较高,点状钙化、正性重塑、餐巾环征的比例较高,而最小管腔面积较小(均P＜0.05).单因素和多因素logistic回归分析结果显示,最小管腔面积(OR=0.303,95%CI 0.178～0.517,P＜0.001)和总动脉粥样硬化体积(OR=1.006,95%CI 1.002～1.010,P=0.003)为稳定性CAD患者病变特异性心肌缺血的独立预测因子.基于CCTA的斑块特征指数预测概率的回归方程为P=1/[1+e-(-1.194 41×MLA+0.006 058×TAV+0.600 912)],其诊断病变特异性心肌缺血的AUC为0.879(95%CI 0.811～0.928),总体诊断准确度、灵敏度、特异度、PPV、NPV分别为 80.0%、83.3%、78.8%、58.8%、92.9%.结论 在稳定性CAD患者中,基于CCTA的斑块特征指数对病变特异性心肌缺血有较高的预测价值,具有良好的临床应用前景.
[Abstract]Objective To explore the predictive value of plaque characteristic index based on coronary CT angiography(CCTA)for disease-specific myocardial ischemia in stable coronary artery disease(CAD).Methods 90 stable CAD patients admitted to Zhongshan Hospital,Fudan University from October 2020 to March 2022 were prospectively enrolled,including 135 target vessels with stenosis degree ranging from 30%to 90%.All participants sequentially underwent CCTA,ICA,and fractional flow reserve(FFR)measurement within 2 weeks.Based on the presence or absence of significant hemodynamic stenosis,all patients were divided into myocardial ischemic population(FFR≤0.8,n=30)and non ischemic population(FFR＞0.8,n= 60),135 target blood vessels were divided into a disease-specific myocardial ischemia group(FFR≤0.8,n=36)and a non disease-specific myocardial ischemia group(FFR＞0.8,n=99).Univariate and subsequent forward stepwise multivariate logistic regression analyses were used to assess independent predictors of myocardial ischemia,and CCTA-derived plaque characteristics index logistic regression model was created.Receiver operating characteristic(ROC)analysis was used to analyze the diagnostic performance of CCTA-derived plaque characteristics index on detecting myocardial ischemia.Results There were no significant differences in age,body mass index,gender,cardiovascular risk factors,and medication between myocardial ischemia population and non-ischemia population.Compared with the non-lesion-specific ischemia group,plaque length,plaque area,percent area stenosis,total atheroma volume,vessel volume and lipid rich volume,positive remodeling and napkin-ring signs were significantly higher in lesion-specific group,while minimum luminal area(MLA)was significantly lower.MLA(OR=0.303,95%CI 0.178-0.517,P＜0.001)and total atheroma volume(TAV,OR=1.006,95%CI 1.002-1.010,P=0.003)were found to be the significant independent predictors of myocardial ischemia.The regression equation of CCTA-derived plaque characteristic index for predicting probability was P=1/[1+e-(-1.194 41×MLA+0.006 058×TAV+0.600 912)].The area under the ROC curve(AUC)of CCTA-derived plaque characteristic index on detecting myocardial ischemia was 0.879(95%CI 0.811-0.928),and the overall diagnostic accuracy,sensitivity,specificity,PPV and NPV were 80.0%,83.3%,78.8%,58.8%,and 92.9%,respectively.Conclusions CCTA-derived plaque characteristic index performs well in diagnosing lesion-specific myocardial ischemia,showing its great clinical application prospect.
徐海嘉;何玮;过伟锋;杨姗;都业弘;陆海锋
复旦大学附属中山医院心内科,上海 200032||上海市心血管病研究所,上海 200032||复旦大学基础医学院,上海 200032复旦大学附属中山医院血管外科,上海 200032复旦大学附属中山医院放射科,上海 200032||上海市医学影像研究所,上海 200032同济大学附属东方医院放射科,上海 200120
临床医学
冠心病;心肌缺血;冠状动脉CT血管造影;斑块特征指数;诊断效能
coronary artery disease;myocardial ischemia;coronary CT angiography;plaque characteristics;diagnostic performance
《中国临床医学》 2024 (002)
200-207 / 8
上海市临床重点专科项目(shslczdzk03202).Supported by Shanghai Municipal Key Clinical Specialty Project(shslczdzk03202).
10.12025/j.issn.1008-6358.2024.20231773
评论