冠状动脉周围脂肪组织及冠状动脉斑块预测CAHD非阻塞性病变进展的临床研究

Clinical Study of Pericoronary Adipose Tissue and Coronary Plaque to Predict the Progression of CAHD Non-obstructive Lesions

目的探讨基于冠状动脉CT血管造影(coronary computed tomography angiogram,CCTA)的基线斑块特征和冠状动脉周围脂肪参数对冠状动脉粥样硬化性心脏病(coronary atherosclerotic heart disease,CAHD)非阻塞性冠状动脉病变进展的影响及预测价值。方法回顾性分析2012-01/2022-06月在作者医院住院期间行CCTA检查的CAHD患者的资料。早期CCTA结果显示为非阻塞性冠状动脉病变,在1~5年的观察期内发生急性心肌梗死、接受血运重建或第二次CCTA检查显示进展为重度及以上的患者为进展组(n=36);同期两次CCTA结果均显示非阻塞性冠状动脉的为对照组(n=57)。对比两组患者的临床资料及CCTA相关参数。分析CCTA相关参数对非阻塞性冠状动脉进展的预测价值。结果两组患者性别构成比较差异具有统计学意义(P<0.05)。两组患者的冠状动脉周围脂肪组织衰减指数(fat attenuation index,FAI)、高危斑块、点状钙化、低密度斑块及狭窄程度组间比较差异具有统计学意义(P均<0.05)。多因素Logistic回归显示,冠状动脉周围FAI、点状钙化及低密度斑块是非阻塞性冠状动脉病变进展的独立危险因素。受试者工作特征(receiver operating characteristic,ROC)曲线分析显示,应用模型冠状动脉周围FAI+点状钙化+低密度斑块联合预测CAHD非阻塞性冠状动脉进展的曲线下面积(area under the curve,AUC)最高(AUC=0.813,P<0.05)。结论基于CCTA的冠状动脉周围FAI、点状钙化及低密度斑块为CAHD非阻塞性冠状动脉进展的影响因素,联合多种参数预测冠状动脉病变进展的价值较高。

Objective To investigate the effects and predictive value of baseline plaque parameters and pericoronary adipose parameters based on coronary computed tomography angiogram(CCTA)on the progression of coronary atherosclerotic heart disease(CAHD)non-obstructive coronary artery disease.Methods The data of CAHD patients who underwent CCTA examination in author′s hospital from January 2012 to June 2022 were retrospectively analyzed.Patients with early CCTA findings of non-obstructive coronary artery disease who experienced acute myocardial infarction,underwent revascularization,or progressed to severe or worse on the second CCTA examination during the obseing period of 1 to 5 years were defined as the progressive group(n=36);the control group(n=57)had non-obstructive coronary artery detected by CCTA twice during the same period.The clinical data and CCTA related parameters of the two groups were compared.The predictive value of CCTA parameters for non-obstructive coronary artery progression was analyzed.Results The difference in gender composition between the two groups was statistically significant(P<0.05).The differences between the two groups were statistically significant between the fat attenuation index(FAI),high risk plaques,punctate calcifications,low-density plaques and stenosis(all P<0.05).Multivariate Logistic regression showed that pericoronary FAI,punctate calcification and low-density plaque were independent risk factors for the progression of non-obstructive coronary artery disease.The receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)was the highest(AUC=0.813,P<0.05)in the combination of pericoronary FAI+punctate calcification+low-density plaque to predict the progression of non-obstructive coronary artery.Conclusion Pericoronary FAI,punctate calcification and low-density plaque based on CCTA are the influencing factors of the progression of non-obstructive coronary artery,and the value of combining various parameters to predict the progression of coronary artery lesions is high.