冠状动脉中度狭窄进行性加重的血流动力学风险因素分析

Analysis on Hemodynamic Risk Factors of Progressive Coronary Stenosis Exacerbation in Patients With Moderate Coronary Artery Stenosis

目的:探究冠状动脉中度狭窄进行性加重冠心病患者的血流动力学特点。方法:回顾性纳入2016年1月至2018年6月冠状动脉造影结果表现为中度狭窄并在1年后再次行冠状动脉造影随访的患者共110例。对比两次影像学结果,判断狭窄是否进一步加重(定义:狭窄加重程度>20%),并根据结果将其分为两组,稳定组(n=85)和加重组(n=25),对纳入病例的第1次血管模型进行血流动力学模拟、分析和定量计算,选择狭窄处的血流涡流数目、血流速度(V)、壁面切应力(WSS)以及壁面压力(WP)作为血流动力学测量指标,最后我们对患者的一般临床特征、影像学特征以及血流动力学特征进行统计分析,从而确定冠状动脉狭窄加重的相关危险因素。结果:110例冠状动脉中度狭窄患者中随访狭窄加重的患者有25例,对比两组发现在一般指标与影像学指标方面差异无统计学意义,而在血流动力学指标方面,稳定组狭窄处的WP值略高于加重组[(4.78±1.29)kPa vs.(4.52±1.54)kPa],而狭窄处V值略低于加重组[(0.55±0.19)m/s vs.(0.61±0.21)m/s],但两者差异均无统计学意义(P均>0.05);涡流数目([1.58±0.98)个vs(.2.47±1.01)个,P<0.05]和WSS值([4.82±1.03)Pa vs(.6.77±1.51)Pa,P<0.05]均低于加重组,差异均有统计学意义。结论:应用高分辨率CT图像可以准确的重建出冠状动脉的三维血管模型。在冠状动脉中度狭窄患者中,其狭窄进一步加重,可能与狭窄处更多的涡流以及更高的WSS值相关。

Objectives:The purpose of this study was to explore the hemodynamic risk factors of coronary stenosis exacerbation in patients with moderate coronary artery stenosis.Methods:We retrospectively reviewed 110 patients with moderate coronary artery stenosis from January 2016 to June 2018 with follow-up imaging after one year.Patients were divided into stable(follow up imaging stenosis severity change<20%)and aggravated(follow up imaging stenosis severity change>20%)groups.We created vascular model for each included case.Hemodynamic simulation,analysis,and quantitative calculations were performed.The included hemodynamic parameters were the number of blood vortexes,velocity(V),wall shear stress(WSS)and wall pressure(WP).We compared the clinical,angiographic,and hemodynamic characteristics between the two groups and determined the risk factors for progressive coronary artery stenosis.Results:Among the 110 patients with moderate coronary artery stenosis,25 patients showed aggravated stenosis in follow-up imaging.The clinical and angiographic characteristics were similar between two groups.For the hemodynamic factors,the WP at the stenosis tended to be higher([4.78±1.29]kPa vs.[4.52±1.54]kPa),the V value at the stenosis tended to be lower([0.55±0.19]m/s vs.[0.61±0.21]m/s)in the stable group than in the aggravated group(P>0.05).However,the vortex number(1.58±0.98 vs.2.47±1.01,P<0.05)and the WSS value([4.82±1.03]Pa vs.[6.77±1.51]Pa,P<0.05)were significantly lower in stable group than in aggravated group(P<0.05).Conclusions:Computational fluid dynamics based on CT images could reconstruct the three-dimensional coronary arterial hemodynamic model accurately.In patients with moderate coronary artery stenosis,further aggravation of the stenosis may be related to more vortex numbers and higher WSS values at the site of the stenosis.