引起冠状动脉功能学缺血性的斑块特征分析

Analysis of Coronary Artery Plaque Characteristics Derived from Coronary CT Angiography to Identify Hemodynamically Significant Coronary Stenosis

目的以有创分数血流储备(FFR)为标准,鉴别引起冠状动脉功能性缺血斑块的影像学特征,进一步提高冠状动脉CT血管造影(CCTA)的诊断效能。方法回顾性纳入2012年9月至2020年1月在本院30天内接受CCTA、有创性冠状动脉造影(ICA)以及导丝FFR检查患者,在CCTA上记录血管狭窄度以及斑块参数,包括非钙化斑块、病变长度、钙化的形态、正性重构、“餐巾环征”、狭窄程度。FFR<0.80的病变被认为功能性缺血性病变。将单因素逻辑回归中有统计学意义的斑块参数纳入多因素模型,受试者工作特征曲线(ROC)分析模型的曲线下面积(AUC),并与单独血管狭窄率模型比较。结果共纳入173例患者[男112例(61.73±8.34岁)]的204枚斑块。将3个单因素有意义的参数(即“餐巾环征”、正性重构、点状钙化)与血管狭窄率共同建立的模型,AUC达到0.837,显著高于单独以血管狭窄率建立的模型(AUC为0.679,P<0.001)。结论研究表明部分高危斑块特征与血管狭窄率组合建模后对于预测有血流动力学意义的狭窄有着更高的准确率。

Objective This study aimed to improve the diagnostic performance of coronary computed tomography angiography(CCTA)via the identification of ischemic coronary stenosis plaque,using invasive fractional flow reserve(FFR)as the reference standard.Methods The patients who underwent CCTA,ICA and FFR examinations within 30 days in our hospital from September 2012 to January 2020 were retrospectively analyzed.The stenosis degree and plaque parameters were recorded on CCTA:(1)non calcified plaque,(2)lesion length,(3)calcification morphology,(4)positive remodeling,(5)napkin ring sign,(6)stenosis degree.The lesion with FFR<0.80 was considered as a functional ischemic lesion.The plaque parameters with statistical significance in univariate logistic regression were included in the multivariate model.The area under the curve(AUC)of the model was analyzed by the receiver operating curve method,and compared with the model built with artery stenosis degree alone.Results One hundred and seventy-three patients(61.73±8.34 years old,112 males)with 204 plaques were included.Three high-risk plaque characteristics with statistical significance(napkin-ring sign,remodeling index,spotty calcification)were used to build the model in combination with the artery stenosis degree.The AUC was 0.837 and was significantly better than the model built with the vessel stenosis degree alone(AUC=0.679,P<0.001).Conclusion This study demonstrated that the combination of high-risk plaque characteristics and artery stenosis degree has a higher diagnostic performance in predicting stenosis with hemodynamic significance.