冠脉CTA定量参数与冠心病患者疾病进展和预后的关系

Relationship between coronary CTA quantitative parameters and disease progression,prognosis of patients with coronary heart disease

目的探讨冠脉螺旋CT造影(CTA)定量参数与冠心病患者疾病进展及预后的关系。方法回顾性分析2020年7月至2021年7月在西安市第九医院确诊的150例冠心病患者的临床诊治和影像资料。所有患者均行冠脉CTA,根据患者检出的病变最严重的血管狭窄程度分为轻度狭窄组25例、中度狭窄组58例和重度狭窄组67例,比较各组患者间的斑块定量参数,采用Spearman相关性分析斑块定量参数与血管狭窄程度的关系,记录各组患者心血管不良事件(MACE)发生情况,采用ROC曲线面积评价斑块定量参数[总斑块负荷(包括钙化与非钙化斑块负荷)、动脉阻力指数(RI)、斑块最小密度]预测冠心病患者发生MACE的价值。结果轻度狭窄组患者与中度狭窄组患者的总斑块负荷、RI值均低于重度狭窄组,斑块最小密度值均高于重度狭窄组,而轻度狭窄组患者的总斑块负荷、RI均低于中度狭窄组,斑块最小密度值高于中度狭窄组,差异均有统计学意义(P<0.05);轻度狭窄组患者发生MACE 9例(36.00%),中度狭窄组发生MACE 29例(50.00%),重度狭窄组发生MACE 54例(80.60%),三组间比较差异具有统计学意义(P<0.01);发生MACE患者的总斑块负荷、RI均高于未发生MACE患者,斑块最小密度值低于未发生MACE患者,差异均有统计学意义(P<0.05);总斑块负荷、RI与血管狭窄程度呈正相关(r=0.344、0.439,P<0.05),斑块最小密度值与血管狭窄程度呈负相关(r=-0.383,P<0.05);ROC曲线分析结果显示,总斑块负荷、RI、斑块最小密度具有预测MACE发生的价值(AUC=0.746、0.776、0.708,P<0.05)。结论冠状CTA斑块定量参数可以评估冠心病患者的疾病发展,对患者的预后有预测的价值。

Objective To explore the relationship between quantitative parameters of coronary spiral CT angiography(CTA)and disease progression,prognosis in patients with coronary heart disease.Methods The clinical diagnosis and imaging data of 150 patients with coronary heart disease confirmed in the Ninth Hospital of Xi'an from July 2020 and July 2021 were retrospectively analyzed.All patients underwent coronary CTA.According to the degree of vascular stenosis with the most severe lesions detected by the patients,they were divided into mild stenosis group(25 cases),moderate stenosis group(58 cases),and severe stenosis group(67 cases).The quantitative parameters of plaques in different groups were compared.The relationship between quantitative parameters of plaques and the severity of vascular stenosis was analyzed by Spearman correlation analysis.The occurrence of major adverse cardiovascular events(MACE)in each group was recorded.The predictive value of quantitative parameters of plaques[total plaque burden(including calcified and non-calcified plaques burden),arterial resistance index(RI),minimum plaque density]for MACE in patients with coronary heart disease was evaluated by area under ROC curve(AUC).Results The total plaque load and RI value of mild stenosis group and moderate stenosis group were lower than those of severe stenosis group,and the minimum density of plaque was higher than that of severe stenosis group;the total plaque load and RI of mild stenosis group were lower than those of moderate stenosis group,and the minimum density of plaque was higher than that of moderate stenosis group;the differences were statistically significant(P<0.05).There were 9 cases(36.00%)of MACE in mild stenosis group,29 cases(50.00%)in moderate stenosis group,and 54 cases(80.60%)in severe stenosis group,with statistically significant differences among the three groups(P<0.01).The total plaque load and RI in MACE patients were higher than those in patients without MACE,while the minimum plaque density was lower than that in patients without MACE,with statistically significant difference(P<0.05).The total plaque load and RI were positively correlated with the severity of vascular stenosis(r=0.344,0.439,P<0.05),while the minimum plaque density was negatively correlated with the severity of vascular stenosis(r=-0.383,P<0.05).The results of ROC curve analysis showed that total load plaque,RI and the minimum plaque density had the value of predicting MACE(AUC=0.746,0.776,0.708,P<0.05).Conclusion Quantitative parameters of coronary CTA can assess the disease development of patients with coro-nary heart disease,which have predictive value for their prognosis.