基于冠状动脉CTA的FFRCT与斑块特征对冠心病患者主要不良心脏事件的预测价值

The Predictive Value of Coronary CTA-derived Fractional Flow Reserve and Atherosclerosis Plaque Characteristics for Major Adverse Cardiac Events in Patients with Coronary Artery Disease

目的:分析基于冠状动脉(冠脉)CT血管成像(CTA)的血流储备分数(FFR_(CT))与斑块特征对冠心病(CAD)患者主要不良心脏事件(MACE)发生的预测价值。方法:回顾性搜集88例CAD患者冠脉CTA资料,测量其FFR_(CT)和斑块特征,并随访CAD患者36个月内MACE发生情况。比较MACE阳性组和阴性组间冠脉解剖狭窄程度、FFR_(CT)和斑块特征的差异,采用多因素逻辑回归方法确定MACE相关的独立危险因素,并采用ROC曲线评价这些参数对MACE的预测价值。结果:MACE阳性组(17例共计17处责任病变)与阴性组(71例共计80支非责任血管)相比,FFR_(CT)、管腔直径狭窄率、斑块最小管腔面积、斑块总体积、血管总体积、非钙化斑块体积、斑块长度、斑块负荷及低密度斑块出现率的差异均有统计学意义(P<0.05)。其中FFR_(CT)≤0.8、管腔直径狭窄率>60.5%、斑块负荷>0.67、斑块长度>19.4mm及低密度斑块出现是MACE发生的独立预测因子。受试者操作特征(ROC)曲线分析中,上述独立预测因子联合后对MACE的预测价值最高[ROC曲线下面积(AUC)为0.821],冠脉解剖狭窄程度(管腔直径狭窄率>60.5%)单一指标的预测价值最低(AUC为0.664)。结论:基于冠脉CTA的解剖狭窄程度与FFR_(CT)、斑块特征(斑块长度、斑块负荷和低密度斑块)联合后,组合指标对CAD患者发生MACE的预测价值优于冠脉解剖狭窄程度单一指标。

Purpose:To analyze the predictive value of fractional flow reserve(FFR_(CT))and plaque characteristics derived from coronary CT angiography(CTA)for major adverse cardiac events(MACE)in patients with coronary artery disease(CAD).Methods:Eighty-eight patients with suspected CAD who had undergone coronary CTA and had follow-up data within 36 months were retrospectively enrolled.The patients were divided into MACE positive group(N=17)and MACE negative group(N=71).Stenosis severity,FFR_(CT)and various plaque characteristics derived from coronary CTA were compared between both groups at per-vessel level.Discriminatory power of independent risk factors for predicting MACE was assessed.Receiver operating characteristics(ROC)curve was used to evaluate the predictive value of these parameters(independent risk factors)for MACE.Results:MACE-related lesions(n=17)had significantly higher values for the minimum lumen area(MLA),diameter stenosis,FFR_(CT),low attenuation plaque(LAP),total plaque volume,total vessel volume,non-calcified plaque volume,plaque length,and plaque burden(P<0.05)compared to the MACE negative lesions(n=80).In a multivariate analysis,the following markers were predictors of MACE:FFR_(CT)T≤0.8,diameter stenosis>60.5%,LAP,plaque burden>0.67,and plaque length>19.4 mm.At ROC analysis,the combination of the above independent risk factors showed the most valuable prediction value for MACE(area under ROC curve:0.821),and at the same time,the diameter stenosis>60.5%has the least valuable prediction value.Conclusion:Combining FFR_(CT),plaque length,plaque burden,and LAP shows incremental prediction power over coronary CTA diameter stenosis for MACE in CAD patients.