Association Among Local Hemodynamic Parameters Derived From CT Angiography and Their Comparable Implications in Development of Acute Coronary Syndrome.
Association Among Local Hemodynamic Parameters Derived From CT Angiography and Their Comparable Implications in Development of Acute Coronary Syndrome.
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DOI：
10.3389/fcvm.2021.713835
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发表时间：
2021
影响因子：
3.6
通讯作者：
Koo BK
中科院分区：
文献类型：
--
作者：
Yang S;Choi G;Zhang J;Lee JM;Hwang D;Doh JH;Nam CW;Shin ES;Cho YS;Choi SY;Chun EJ;Nørgaard BL;Nieman K;Otake H;Penicka M;Bruyne B;Kubo T;Akasaka T;Taylor CA;Koo BK
背景：局部血流动力学参数之间的关系及其在急性冠脉综合征(ACS)发生中的意义尚未得到充分的研究。方法：分析急性冠脉综合征患者发病后1~24个月前行冠状动脉CT血管造影(CCTA)的216处病变。颈动脉高危斑块定义为≥-2低密度斑块、阳性重构、点状钙化和餐巾环征。通过计算流体力学分析，得到由颈总动脉计算的血流储备分数(FFRCT)和局部血流动力学参数，包括壁面切应力、斑块轴向应力、跨病变压力梯度(PG)和跨病变增量血流储备(Δ)。比较了局部血流动力学之间的关系及其对罪犯病变和非罪犯病变的区分能力。结果：共发现66个致病因素病变和150个非致病因素病变。WSS、APS、PG和ΔFFRCT之间有很强的相关性(均为p<；0.001)。根据血管、病变位置、解剖严重程度、高风险斑块或FRCT≤0.80，这种关联在所有病变亚型中持续存在。在区分导致急性冠脉综合征的罪魁祸首病变和非罪魁祸首病变方面，在调整病变特征、高危斑块和Δ≤0.80后，WSS、PG、APS和FFRCT是独立的预测因子；所有局部血流动力学参数都显著提高了高危斑块和FFRCT≤0.80的罪魁祸首病变的预测值(均P<0.05)。FFRCT≤0.80、高危斑块和ΔFFRCT对罪犯病变的风险预测能力与FFRCT≤0.80、高危斑块和WSS、AP或PG的识别能力相似或更好；在ΔFFRCT中加入WSS、AP或PG并没有改善模型的性能。结论：局部血流动力学指标显著相关，所有指标对高危斑块和受损的FFRCT的急性冠脉综合征风险提供了类似的附加和独立预测值。
Background: Association among local hemodynamic parameters and their implications in development of acute coronary syndrome (ACS) have not been fully investigated. Methods: A total of 216 lesions in ACS patients undergoing coronary CT angiography (CCTA) before 1–24 months from ACS event were analyzed. High-risk plaque on CCTA was defined as a plaque with ≥2 of low-attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign. With the use of computational fluid dynamics analysis, fractional flow reserve (FFR) derived from CCTA (FFRCT) and local hemodynamic parameters including wall shear stress (WSS), axial plaque stress (APS), pressure gradient (PG) across the lesion, and delta FFRCT across the lesion (ΔFFRCT) were obtained. The association among local hemodynamics and their discrimination ability for culprit lesions from non-culprit lesions were compared. Results: A total of 66 culprit lesions for later ACS and 150 non-culprit lesions were identified. WSS, APS, PG, and ΔFFRCT were strongly correlated with each other (all p < 0.001). This association was persistent in all lesion subtypes according to a vessel, lesion location, anatomical severity, high-risk plaque, or FFRCT ≤ 0.80. In discrimination of culprit lesions causing ACS from non-culprit lesions, WSS, PG, APS, and ΔFFRCT were independent predictors after adjustment for lesion characteristics, high-risk plaque, and FFRCT ≤ 0.80; and all local hemodynamic parameters significantly improved the predictive value for culprit lesions of high-risk plaque and FFRCT ≤ 0.80 (all p < 0.05). The risk prediction model for culprit lesions with FFRCT ≤ 0.80, high-risk plaque, and ΔFFRCT had a similar or superior discrimination ability to that with FFRCT ≤ 0.80, high-risk plaque, and WSS, APS, or PG; and the addition of WSS, APS, or PG into ΔFFRCT did not improve the model performance. Conclusions: Local hemodynamic indices were significantly intercorrelated, and all indices similarly provided additive and independent predictive values for ACS risk over high-risk plaque and impaired FFRCT.
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影响因子：
24
作者：
Fukumoto, Yusaku;Hiro, Takafumi;Matsuzaki, Masunori
通讯作者：
Matsuzaki, Masunori
影响因子：
24
作者：
Kumar, Arnav;Thompson, Elizabeth W.;Samady, Habib
通讯作者：
Samady, Habib
影响因子：
39.3
作者：
Costopoulos, Charis;Timmins, Lucas H.;Bennett, Martin R.
通讯作者：
Bennett, Martin R.
冠状动脉微血管抵抗：其在人类中进行定量的方法。
影响因子：
9.5
作者：
Knaapen P;Camici PG;Marques KM;Nijveldt R;Bax JJ;Westerhof N;Götte MJ;Jerosch-Herold M;Schelbert HR;Lammertsma AA;van Rossum AC
通讯作者：
van Rossum AC
影响因子：
24
作者：
Motoyama, Sadako;Ito, Hajime;Narula, Jagat
通讯作者：
Narula, Jagat