缺血伴非阻塞性冠状动脉疾病与阻塞性冠状动脉疾病的CT解剖与功能对比研究

The comparison of anatomical and functional features between patients with ischemic with non-obstructive coronary artery disease and obstructive coronary artery disease by CT

目的探讨缺血伴非阻塞性冠状动脉疾病(INOCA)和阻塞性冠状动脉疾病(CAD)患者的冠状动脉血管和斑块、心肌灌注以及心功能特征的差异。方法回顾性纳入空军军医大学第一附属医院2021年7月至2022年6月因心绞痛等症状可疑CAD和心肌缺血并接受冠状动脉CT成像(CCTA)和动态负荷CT心肌灌注(CTP)成像的患者101例。根据CCTA和CTP结果,将患者分为INOCA 27例、中度阻塞性CAD 26例和重度阻塞性CAD 48例,分析所有患者的冠状动脉解剖学狭窄、斑块特征和心肌灌注特征。此外,对CCTA进行全心动周期重建,使用Medis Suite 3.2软件对图像进行分析,获得左心室的整体纵向应变(GLS)、整体圆周应变(GCS)和整体径向应变(GRS)。多组间分析采用单因素方差分析或Kruskal-Wallis H检验。结果INOCA患者的年龄低于中度和重度阻塞性CAD患者(P<0.001)。INOCA患者的正性重构发生率(7.4%,2/27)低于中度(57.7%,15/26,P<0.001)和重度阻塞性CAD患者(33.3%,16/48,P=0.017)。INOCA患者的缺血心肌体积占比与重度阻塞性CAD患者差异无统计学意义(P均>0.05),但均高于中度阻塞性CAD患者(P均<0.05)。此外,INOCA患者的GLS[-17.4%(-21.6%,-11.6%)]与重度阻塞CAD患者差异并无统计学意义[-17.6%(-21.9%,-14.8%),P=0.536],但均显著高于中度阻塞性CAD患者[-22.3%(-29.8%,-19.0%),P<0.05]。结论基于CTP联合CCTA成像“一站式”测量的INOCA患者的异常心肌灌注和心肌应变等早期心功能改变与重度阻塞性CAD患者类似,且比中度阻塞性CAD患者更严重。

ObjectiveTo explore the difference of the vessel and plaque characteristics,myocardial perfusion and cardiac function between patients with ischemia with non-obstructive coronary artery disease(INOCA)and obstructive coronary artery disease(CAD).MethodsFrom July 2021 to June 2022,101 patients with angina were referred to dynamic computed tomography myocardial perfusion(CTP)and coronary computed tomography angiography(CCTA)and retrospectively included in our hospital.Based on the results of CTP and CCTA,patients were divided into INOCA(27 cases),moderate obstructive CAD(26 cases)and severe obstructive CAD(48 cases).The anatomical coronary artery stenosis,plaque characteristics and myocardial perfusion features of all patients were analyzed.Furthermore,left ventricular global longitudinal strain(GLS),global circumferential strain(GCS),and global radial strain(GRS)were obtained on full-phase reconstruction CCTA image by using Medis Suite 3.2 postprocessing software.Multigroup analysis used one way ANOVA or Kruskal Wallis H test.ResultsPatients with INOCA were younger than patients with moderate and severe obstructive CAD(P<0.001).INOCA patients(7.4%,2/27)had lower rate of positive remodeling than both moderate(57.7%,15/26,P<0.001)and severe obstructive CAD patients(33.3%,16/48,P=0.017).The percentage of ischemic myocardium volume in patients with INOCA were similar with those in patients with severe CAD(all P>0.05),but significantly higher than those in patients with moderate CAD(all P<0.05).No significant difference in terms of GLS was detected between patients with INOCA[-17.4%(-21.6%,-11.6%)]and severe CAD[-17.6%(-21.9%,-14.8%),P=0.536],however,patients both with INOCA and severe CAD also had higher GLS than patients with moderate obstructive CAD[-22.3%(-29.8%,-19.0%),all P<0.05].ConclusionsBased on"one-stop-shop"CTP combined with CCTA imaging,early cardiac functional changes including abnormal myocardial perfusion and myocardial strain in INOCA patients were similar to those in patients with severe obstructive CAD and more severe than those in patients with moderate obstructive CAD.