Vulnerable plaque features on coronary CT angiography as markers of inducible regional myocardial hypoperfusion from severe coronary artery stenoses.
Vulnerable plaque features on coronary CT angiography as markers of inducible regional myocardial hypoperfusion from severe coronary artery stenoses.
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DOI：
10.1016/j.atherosclerosis.2011.07.128
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发表时间：
2011-12
期刊：
影响因子：
5.3
通讯作者：
Berman, Daniel S.
中科院分区：
文献类型：
--
作者：
Shmilovich, Haim;Cheng, Victor Y.;Tamarappoo, Balaji K.;Dey, Damini;Nakazato, Ryo;Gransar, Heidi;Thomson, Louise E. J.;Hayes, Sean W.;Friedman, John D.;Germano, Guido;Slomka, Piotr J.;Berman, Daniel S.
关键词：
我们探讨了冠状动脉CT血管成像(CCTA)上斑块易损性的3个已知特征--低密度斑块含量(LAP)、阳性重构(PR)和点状钙化(SC)--是否能识别与心肌灌注成像(MPI)测量的更大的可诱导性心肌低灌注量相关的斑块。我们分析了49例无心脏病的患者，这些患者在6个月内接受了CCTA和MPI，发现CCTA上有70%-99%的局灶性狭窄，主要是1条主要冠状动脉近段或中段的非钙化斑块。测量LAP(≤30Hounsfield Units)、PR(外壁直径比近端参考直径超出≥5%)和SC(≤长3 mm，占≤横断面动脉周长90°)。在MPI上，病变动脉对应的心肌区的可逆性低灌注率由自动算法以占总心肌的百分比(RevTPDART)和由两位有经验的读者以总差值(SDSART)来量化。REVTPDART≥3%和SDSART≥3定义了病变动脉区域显著的可诱导低灌注率。在患有RevTPDART≥的患者中，LAP(70%比14%，p<；0.001)和PR(70%比24%，p=0.001)的发生率高出3%，但SC(55%比34%，p=0.154)。LAP−/PR−斑块的RevTPDART由1.3±1.2%增加到LAP+/PR−或LAP−/PR+斑块的3.2±4.3%和8.3±2.4%(p<；0.001)；使用相同的LAP/PR分类，由RevTPDART≥3%(1/19至10/21至9/9，p<；0.001)和SDSART≥3(1/19至8/21至8/9，p<；0.001)确定的显著低灌注率显著增加。在调整潜在混杂因素的回归模型中，LAP和PR，而不是SC，是RevTPDART和SDSART的强大预测因子。在CCTA上，在严重狭窄的斑块中出现低密度斑块和正性重构是心肌低灌注的强烈预测，并可能有助于评估此类病变的血流动力学意义。
We explored whether the presence of 3 known features of plaque vulnerability on coronary CT angiography (CCTA) – low attenuation plaque content (LAP), positive remodeling (PR), and spotty calcification (SC) – identifies plaques associated with greater inducible myocardial hypoperfusion measured by myocardial perfusion imaging (MPI). We analyzed 49 patients free of cardiac disease who underwent CCTA and MPI within a 6-month period and were found on CCTA to have focal 70–99% stenosis from predominantly non-calcified plaque in the proximal or mid segment of 1 major coronary artery. Presence of LAP (≤30 Hounsfield Units), PR (outer wall diameter exceeds proximal reference by ≥5%), and SC (≤3mm long and occupies ≤90° of cross-sectional artery circumference) were determined. On MPI, reversible hypoperfusion in the myocardial territory corresponding to the diseased artery was quantified both as percentage of total myocardium (RevTPDART) by an automatic algorithm and as summed difference score (SDSART) by two experienced readers. RevTPDART≥3% and SDSART≥3 defined significant inducible hypoperfusion in the territory of the diseased artery. Plaques in patients with RevTPDART≥3% more frequently exhibited LAP (70% vs. 14%, p<0.001) and PR (70% vs. 24%, p=0.001) but not SC (55% vs. 34%, p=0.154). RevTPDART increased from 1.3±1.2% in arteries with LAP−/PR− plaques to 3.2±4.3% with LAP+/PR− or LAP−/PR+ plaques to 8.3±2.4% with LAP+/PR+ plaques (p<0.001); SDSART showed a similar increase: 0.3±0.7 to 2.3±2.8 to 6.0±3.8 (p<0.001). Using the same LAP/PR categorization, there was a marked increase in the frequency of significant hypoperfusion as determined by both RevTPDART≥3% (1/19 to 10/21 to 9/9, p<0.001) and SDSART≥3 (1/19 to 8/21 to 8/9, p<0.001). LAP and PR, but not SC, were strong predictors of RevTPDART and SDSART in regression models adjusting for potential confounders. Presence of low attenuation plaque and positive remodeling in severely stenotic plaques on CCTA is strongly predictive of myocardial hypoperfusion and may be useful in assessing the hemodynamic significance of such lesions.
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