冠状动脉周围脂肪衰减指数、冠状动脉狭窄程度及肝脏脂肪含量与心肌缺血的关系研究

Study on the Relationship of Myocardial Ischemia with Pericoronary Fat Attenuation Index,Degree of Coronary Artery Stenosis and Liver Fat Content

目的:探讨冠状动脉周围脂肪衰减指数(FAI)、冠状动脉狭窄程度及肝脏脂肪含量与冠状动脉CT血流储备分数(CT-FFR)确定的心肌缺血的关系。方法:回顾性收集2014年5月-2022年9月在本院经冠状动脉CT血管成像(CCTA)检查发现有冠状动脉狭窄的229例患者资料,测量其冠状动脉狭窄程度、FAI和CT-FFR。将CT-FFR≤0.80和>0.80者分别归为心肌缺血组(n=74例)和非缺血组(n=155例)。受试者均行腹部CT平扫,采用QCT Pro软件测量其肝脏脂肪分数。比较上述各指标在2组间的差异,并将其纳入二元logistic回归分析,筛选出心肌缺血的独立危险因素,并利用受试者工作特征(ROC)曲线评估各因素单独或联合对预测心肌缺血的诊断效能。结果:冠状动脉三支大血管FAI值及FAI均值、冠状动脉狭窄程度、肝脏脂肪分数在心肌缺血组与非缺血组间的差异均有统计学意义(P<0.05)。单因素logistic回归分析发现上述指标可能是心肌缺血的影响因素;多因素logistic回归分析显示,FAI均值(OR=1.155,95%CI 1.088~1.226)、冠状动脉狭窄程度(OR=7.435,95%CI 3.708~14.908)是心肌缺血的独立危险因素。FAI均值、冠状动脉狭窄程度单独及两者联合预测模型的ROC曲线下面积(AUC)分别为0.724、0.738、0.828,联合模型与2个单一指标模型比较,AUC差异均有统计学意义(Z=3.311,P=0.000 9;Z=4.185,P<0.000 1)结论:随着肝脏脂肪含量增加,冠状动脉狭窄的患者更易发生心肌缺血。FAI均值、冠状动脉狭窄程度是CT-FFR确定的心肌缺血的独立危险因素,两者均对心肌缺血有一定预测价值,且两者联合预测模型效能更佳。

Purpose:To investigate the relationship between myocardial ischemia as determined by coronary CT fractional flow reserve(CT-FFR),coronary perivascular fat attenuation index(FAI),degree of coronary artery stenosis and liver fat content.Methods:This retrospective study collected data from 229 patients who underwent coronary CT angiography(CCTA)and were found to have coronary artery stenosis between May 2014 and September 2022 in our hospital.Degree of coronary artery stenosis,FAI,and CT-FFR were measured.Patients were divided into the myocardial ischemia group(n=74)and the non-ischemia group(n=155)based on CT-FFR≤0.80 and>0.80,respectively.All subjects underwent abdominal CT scans,and liver fat content was measured using QCT Pro software.Differences in the aforementioned indicators between the two groups were compared,and binary logistic regression analysis was performed to identify independent risk factors for myocardial ischemia.The diagnostic performance of each factor,both individually and in combination,was evaluated using receiver operating characteristic(ROC)curves.Results:Significant differences in the FAI values of the three major coronary arteries,the mean FAI,degree of coronary artery stenosis,and liver fat content between myocardial ischemia and nonischemia groups were observed(P<0.05).Univariate logistic regression analysis suggested that these indicators could influence myocardial ischemia.Multivariate logistic regression analysis revealed that the mean FAI(OR=1.155,95%CI 1.088-1.226)and degree of coronary artery stenosis(OR=7.435,95%CI 3.708-14.908)were independent risk factors for myocardial ischemia.The AUC for predicting myocardial ischemia using the mean FAI,degree of coronary artery stenosis,and their combined model were 0.724,0.738,and 0.828,respectively.The combined model showed statistically significant improvements in the area under ROC curve(AUC)compared to the single-indicator models(Z=3.311,P=0.0009;Z=4.185,P<0.0001).Conclusions:With the increase of liver fat content,patients with coronary artery stenosis are more prone to myocardial ischemia.Both the mean FAI and degree of coronary artery stenosis are independent risk factors for myocardial ischemia determined by CT-FFR,with both showing predictive value for myocardial ischemia.The combined predictive model of these factors demonstrates superior performance.