冠状动脉CT血管成像定量评估冠心病心肌缺血的效能

Value of coronary CT angiography in quantitative assessment of myocardial ischemia in patients with coronary heart disease

目的探讨基于冠状动脉CT血管成像(CCTA)的斑块定量分析评估冠心病心肌缺血的效能。方法选择2019年10月至2020年12月衢州市中医医院收治的147例冠心病患者,所有患者均接受冠状动脉造影(ICA)、CCTA检查;根据ICA下测量的心肌血流储备分数(FFR),将患者分为心肌缺血组66例和非心肌缺血组81例,比较两组患者一般资料、斑块成分参数(病变长度、钙化斑块体积比、非钙化斑块体积比、斑块负荷、血管狭窄程度)、斑块形态特征参数(正性重构、低密度斑块、餐巾环征、点状钙化)的差异。将同时具备2个高危征象的斑块定义为CT高危斑块。采用logistic回归分析影响冠心病心肌缺血的独立危险因素,采用ROC曲线分析斑块参数评估心肌缺血的诊断效能。结果心肌缺血组患者正性重构比例、餐巾环征比例、CT高危斑块比例、病变长度、斑块负荷、血管狭窄程度均明显高于非心肌缺血组(均P<0.05);logistic回归分析显示,CT高危斑块、病变长度、斑块负荷、血管狭窄程度是冠心病心肌缺血的独立危险因素(均P<0.05);ROC曲线分析显示,CT高危斑块、病变长度、斑块负荷、血管狭窄程度、联合检测评估心肌缺血的AUC分别为0.597、0.662、0.698、0.735、0.824,其中联合检测的评估价值明显高于单一指标(Z=4.697、3.546、3.141、2.460,均P<0.05)。结论基于CCTA的CT高危斑块、病变长度、斑块负荷、血管狭窄程度是冠心病心肌缺血的独立危险因素,联合检测能够提升心肌缺血的诊断效能。

Objective To evaluate the application of quantitative plaque analysis based on coronary CT angiography(CCTA)in assessing myocardial ischemia in patients with coronary heart disease.Methods A total of 147 patients with coronary heart disease(CHD)were enrolled in Quzhou Hospital of TCM from October 2019 to December 2020.All patients underwent invasive coronary angiography(ICA)and CCTA.The patients were classified into myocardial ischemia group(n=66)and the non-myocardial ischemia group(n=81)according to the fractional flow reserve(FFR)based on ICA detection.The general information,plaque quantitative parameters and plaque characteristics of the two groups were compared.Logistic regression was used to analyze the factors related to myocardial ischemia in CHD.Receiver operating characteristic curve(ROC)was used to analyze the value of plaque parameters in assessing myocardial ischemia.Results The proportion of positive remodeling,napkin ring sign and CT high-risk plaques,lesion length,plaque load and degree of vascular stenosis in myocardial ischemia group were significantly higher than those in non-myocardial ischemia group(P<0.05).Logistic regression analysis showed that CT high-risk plaques,lesion length,plaque load and degree of vascular stenosis were independent risk factors for myocardial ischemia(P<0.05).ROC curve analysis showed that the area under curve(AUC)of lesion length,plaque load,degree of vascular stenosis,CT high-risk plaque and combined detection in evaluating myocardial ischemia were 0.597,0.662,0.698,0.735,0.824,respectively,and that of the combined detection was significantly higher than that of single index(Z=4.697,3.546,3.141,2.460,P<0.05).Conclusion CT high risk plaques,lesion length,plaque load and degree of vascular stenosis are independent risk factors for myocardial ischemia,and combined detection can improve the diagnostic value of myocardial ischemia.