冠状动脉CT血管造影血管斑块特点与狭窄情况预测心肌缺血的效能

Efficacy of coronary CT angiography plaque characteristics and stenosis in predicting myocardial ischemia

目的探究冠状动脉CT血管造影(CCTA)血管斑块特点与狭窄情况预测心肌缺血的效能。方法选取2019年1月至2020年12月咸宁市第一人民医院接收疑诊或已知的冠心病患者88例(病变血管196支)作为研究对象,入选患者在入院后均接受CCTA、冠状动脉造影(CAG)与血流储备分数(FFR)检查,金标准为心肌FFR测定值,根据FFR值分为缺血组(n=45,99支病变血管,FFR值≥0.8)与非缺血组(n=43,97支病变血管,FFR值<0.8)。回顾性分析两组患者临床基线资料,比较两组患者CCTA血管斑块特点、血管狭窄情况,分析CCTA血管斑块特点、血管狭窄率诊断心肌缺血的价值。结果缺血组病变血管狭窄程度重于非缺血组,差异有统计学意义(P<0.05)。检查结果显示,缺血组病变血管斑块负荷、斑块体积、钙化积分高于非缺血组,病变长度低于非缺血组,CT高危斑块、低密度斑块多于非缺血组,差异有统计学意义(P<0.05);ROC分析显示,CCTA病变血管狭窄率(>75%狭窄)、CT高危斑块、病变长度、联合检测预测心肌缺血的AUC分别为0.626、0.605、0.696、0.759。结论CCTA血管斑块特点、血管狭窄率预测患者心肌缺血的效能良好,两者联合可作为心肌缺血的重要诊断指标。

Objective To investigate the efficacy of coronary CT angiography(CCTA)in predicting myocardial ischemia with Coronary plaque characteristics and stenosis.Methods From January 2019 to December 2020,88 patients with suspected or known coronary heart disease(196 diseased vessels)admitted to Xianning First People′s Hospital were selected as the study subjects.After admission,all the enrolled patients received CCTA,coronary artery angiography(CAG)and Fractional flow reserve(FFR)examination,and the gold standard was the cardiac FFR value.According to FFR value,they were divided into ischemic group(n=45,99 vessels with lesion,FFR value≥0.8)and non-ischemic group(n=43,97 vessels with lesion,FFR value<0.8).The clinical baseline data of the two groups were retrospectively analyzed,and the characteristics of CCTA plaque and the stenosis of the two groups were compared.The value of THE characteristics of CCTA plaque and the stenosis rate in the diagnosis of myocardial ischemia were analyzed.Results The degree of stenosis in the ischemic group was more severe than that in the non-ischemic group,and the difference was statistically significant(P<0.05).The results showed that the vascular plaque load,plaque volume and calcification score in the ischemic group were higher than those in the non-ischemic group,and the lesion length was lower than that in the non-ischemic group,with statistical significances(P<0.05).CT high-risk plaque and low-density plaque were more than those in the non-ischemic group,with statistical significances(P<0.05).ROC analysis showed that the AUC of CCTA lesion stenosis rate(>75%stenosis),CT high-risk plaque,lesion length and combined detection in predicting myocardial ischemia were 0.626,0.605,0.696 and 0.759,respectively.Conclusion CCTA has good efficacy in predicting myocardial ischemia in patients with vascular plaque characteristics and vascular stenosis rate,and the combination of CCTA and CCTA can be used as an important diagnostic index of myocardial ischemia.