CT冠状动脉定量在评估冠心病患者心肌缺血诊断中的应用价值

Application Value of Coronary CT Angiography Quantification in the Diagnosis of Myocardial Ischemia in Patients with Coronary Heart Disease

目的探讨CT冠状动脉(CCTA)定量在评估冠心病(CHD)患者心肌缺血诊断中的应用价值。方法选取2021年1月至2023年5月本院收治的CHD患者106例,按照冠状动脉造影(ICA)测定的心肌血流储备分数(FFR),将患者分为无心肌缺血组和心肌缺血组,两组分别52例、54例。对比两组CCTA冠脉不同狭窄程度的影像学表现;比较两组患者斑块形态特征指标(点状钙化、餐巾环征、低密度斑块)和其它斑块定量指标[病变长度(PL)、狭窄程度(DS)、斑块负荷(PB)、斑块体积(PV)、钙化积分(CS)、重建指数(RI)];采用受试者特征曲线(ROC)分析斑块形态特征联合成分定量指标对CHD心肌缺血的诊断价值。结果两组患者斑块形态特征指标(点状钙化、低密度斑块)无差异(P>0.05),心肌缺血组餐巾环征比例高于无心肌缺血组(P<0.05)。心肌缺血组斑块定量指标(PL、DS、PB、RI、CS)均高于无心肌缺血组(P<0.05)。PL、CS、PB、DS、RI诊断冠心病心肌缺血的AUC分别为0.744、0.814、0.726、0.859、0.826,截断值分别为19.83、185.41、34.64、46.66、0.95,联合检测的AUC为0.953,高于单个指标诊断(P<0.05)。结论与无心肌缺血患者相比,心肌缺血CHD患者斑块PL、CS、PB、DS、RI均增加;临床可以通过检测上述指标诊断CHD心肌缺血,且联合诊断价值更高。

Objective To explore the application value of coronary CT angiography(CCTA)quantification in the diagnosis of myocardial ischemia in patients with coronary heart disease(CHD).Methods A total of 106 patients with CHD admitted to the hospital were enrolled between January 2021 and May 2023.According to myocardial fractional flow reserve(FFR)by coronary angiography(ICA),patients were divided into non-ischemia group(52 cases)and ischemia group(54 cases).The imaging findings,morphological characteristics indexes of plaques(punctate calcification,napkin ring sign,low-density plaque)and the other quantitative indexes[plaque length(PL),degree of stenosis(DS),plaque burden(PB),patch volume(PV),calcification score(CS),reconstruction index(RI)]were compared between the two groups.The diagnostic value of morphological characteristics indexes combined with quantitative indexes of components for myocardial ischemia was analyzed by receiver operating characteristic(ROC)curves.Results There was no difference in morphological characteristics indexes of plaques(punctate calcification,low-density plaque)between the two groups(P>0.05),but the proportion of napkin ring sign in ischemia group was higher than that in non-ischemia group(P<0.05).The plaque quantitative indexes(PL,DS,PB,RI,CS)in ischemia group were higher than those in non-ischemia group(P<0.05).AUC and cut-off values of PL,CS,PB,DS and RI in the diagnosis of myocardial ischemia were(0.744,0.814,0.726,0.859,0.826)and(19.83,185.41,34.64,46.66,0.95),respectively.AUC of combined detection was 0.953,greater than that of single index(P<0.05).Conclusion Compared with CHD patients without myocardial ischemia,PL,CS,PB,DS and RI are increased in those with myocardial ischemia.Clinically,the above indexes can be applied in the diagnosis of myocardial ischemia,and diagnostic value of combined detection is higher.